Tuesday, April 30, 2013

Guest post: Two weeks

I know I am imperfect all the time, but I felt particularly so during my recent two weeks on the wards.  Although I enjoy teaching the team of residents and students and doing some intensive patient care, it is also very hard.  And this was my first time on the wards since maternity leave, which was even harder.

One Saturday night, I was getting ready to leave the hospital at 8 pm.  My team had been admitting during the day and dealing with some other complicated issues, so I had stayed late.  I could have stayed even longer, but it was getting to be Baby’s bedtime.  I wanted to be at home for that and the team was under control.  Guilt-about-staying-at-work was slightly stronger than guilt-about-going-home, so it was time to go home.

I called my husband to come pick me up.  On weekend nights, there is no parking near where we live and we’re better off walking rather than moving the car.  We are within a 30-minute walk from the hospital.  We decided on the phone that Daddy would bring Baby in the stroller and we would all walk home together.  It seemed like a good idea at the time.

Baby usually likes walks in the stroller, but not this time.  He cried almost the whole way home.  And so did I.  He was hungry and tired and wanted his mama.  I was hungry and tired too and could not stand the sound of his distress.  Of course, it also started raining on us.  Not our finest hour. 

He forgot about all this as soon as we got home and put him to bed, but I continue to feel bad about being torn between work and home.  I have to remind myself to focus on the positive though.  Despite having a very busy service, I managed to sneak over to the OB floor to pump every 4 hours or so and sustain Baby’s feeding.  I am glad that my difficult weeks are interspersed with some easier ones, when I can spend more time with him.  And I am thankful that Baby has a wonderful Daddy to help take care of him.  All we can do is our best, even when it doesn’t always feel like enough. 

TaborF blogs at Tea with Dr. Tabor.

Why doesn't your mom just...

Setting:  tree pollen infested suburb of our nation's capital, springtime

son's friend (unaffected) 
son (with puffy eyelids and superficial excoriations on arms/back/legs)
mom (pediatrician, imperfect)

Act I: morning, breakfast

MOM: (places drops in son's eyes, sprays up son's nose, 10 ml syringe generic nonsedating antihistamine in son's mouth).  Have a good day, sweetie.

SON: (blinking, sniffing, rubbing, scratching...  yet smiling.)  Thanks mom.

Act II: school, lunchtime

SON'S FRIEND:  (inquisitively) Hey, why doesn't your mom just take you to the doctor?

SON: (emphatically) Because my mom is a doctor.

                --  The end --

Summary:  A mother in medicine recognizes that despite everything she (as a pediatrician) knows how to do, and everything she (as a mother) wants to do for her son, she is imperfect in her ability to cure all.  Drops, sprays, creams, liquids for her patients...  plus kisses for her own son.

Epilogue: This mother in  medicine recognizes, more painfully, that she cannot prevent or cure cancer in her own parents. She can understand and translate the fast talking teams of surgeons, anesthesiologists, oncologists, radiologists.  And she can be there with support, a lot of love, and a little laughter amidst the tears.

Guest post: The Medical Student Mom Guilt

I knew I was crazy on probably the eighth hour into the first leg of the drive. I was perhaps one of the only people in my medical school class I knew of that took their family along for the ride that was two, back-to-back away rotations. Both of them were located quite a distance away.  Through the magic of Disney movies and some well-planned vacation weeks in between rotations, I managed to break up the tough, away schedules and lengthy drives with visits to family along the way. Sounds insane, right? What sort of mother takes their toddler out of Mother’s Morning Out (ironically named since my husband is the stay-at-home dad) to traverse the country with nonstop Cars, Over the Hedge and Disney movies?

Needless to say, I felt horribly guilty. It’s the same guilt you feel when you judge yourself against the mothers who have their children in play-based preschool programs. You know the ones. These are where the kids gather eggs every morning, feed bunnies and take woodland walks. Except your child is not that child.  My toddler was the kid sitting in the car watching another run of Mater’s Tall Tales while their mother drags them cross-country for a rotation.  Sometimes it gets a little lonely to keep hearing, “I can’t believe you brought your family to your aways.” Let’s not even talk about interview season. That is a whole ‘nother post of mother failure, right?

This guilt was nothing new to me. I blamed myself throughout medical school. Whether it was working on USMLE World from my mobile phone while holding my kid as he watched Sesame Street in the mornings, or it was trading my son out in shifts when I was newly postpartum so I could prepare for a test, I never felt like I was giving him what he deserved.

Was I a horrible mother? Medical school has definitely not made me the homemade baby-food making mama I had hoped to be, and I am horribly embarrassed to announce that my son is still not potty-trained. We gave up our apartment at the end of this year, and we moved home with my family to save money and help some family members in need of care. We will also visit some other family directly after graduation, so I seriously wonder if he is ever going to sit on a potty without hysterical tears until we finally get settled in our new home for residency.

I judge myself constantly. If I were not a medical student mom, I could have given my child a more even-keel life filled with playgroups, museum activities, more reading and less TV. Should I be doing those things despite needing to study and handle school and fatigue? Should I have done more anyway? Maybe sucked it up, because darn it – medical school moms are supposed to be smart and manage the house and family? Having it all and doing it all, right? 

Now I’m looking backwards. I am less than two weeks from graduation as I write this, and I still judge myself for decisions I made in medical school. We did survive the away rotations despite living in a 350-sq ft apartment for one of them. We survived each of the Step exams and third year. We even survived a crazy interview season that involved many flights, and I matched somewhere that is perfect for my family. However, did I do enough of the right things to balance out the wrong ones? Should I just be thankful Sesame Street and Super Why! have taught my toddler all his letters and numbers? (Thanks PBS!) I don’t really know, but I console myself that he is a loving, sweet toddler who seems to somehow really love me.  I don’t know if mothers can have it all anymore, but I do know that I’m sure going to keep trying to be a good mother and a good physician, and I think that will be the “all” I want.

ToddlerMamaMD blogs at Mommd.com.

Monday, April 29, 2013

Imperfection Trumps Perfection

I used to think that being perfect was the ideal.  Now I embrace imperfection.  It all started a few years ago, when I got divorced.  I have written here a little about my divorce before, not wanting to repeat myself, but time and experience brings fresh perspective to the past.

My marriage to my physician ex, my kid's dad, started to go downhill when I was in residency and we started a family.  Neither of us were equipped to have intelligent discussion about it, so we shoved our problems under the rug, I as much as he.  I projected an image to the world, my world - residents and attendings and future job possibilities - that everything was peachy keen.  Turns out the person I was most fooling was myself.  It took a long time and a lot of counseling to admit that; first to myself, then to him, then to our world.

I feared honesty.  Mostly for my kids.  Sure, all marriages struggle, but ours was gasping for air.  My daughter, Cecelia, at age 4 could see it.  "Mom, how come we never do things as a family?  I do things with daddy, and I do things with you.  Aunt Annie and Uncle Dave seem so happy - they touch and hug.  Why don't you and daddy do that?"  Children's words cut to the quick.  There comes a point when you worry that the fantasy you are creating for yourself and those around you is detrimental to your children.  What was I modeling?  Certainly not good relationship.

I recently read a book from one of our guest posters, Melissa Yuan-Innes, called The Most Unfeeling Doctor in the World.  She writes comical and insightful short essays in this one of her many books about medicine.  The essay I am remembering while writing this post describes her desire to switch from a Type A to a Type B personality.  She takes it on, Type A style, both successfully and unsuccessfully.  Which is to say she mostly fails, but in her failure she wins awareness.  We can't really change who we are, but we can damn well try and usually gain something from the effort.  I empathized with her as I read, jokingly (um, half seriously actually) thinking of her as my Canadian twin.

I hike.  I do yoga.  I run.  I read voraciously.  I drink way too much coffee.  I am a single mother.  I am a doctor.  I burn the candle at both ends.  I do the best I can with the Type A personality that was hard-wired from birth.  Everything I attack is Type A - parenting, relationship, and work.  If I find myself with a short block of free time I reflexively fill it with activity, only later reflecting that I might have spent it better sitting on the couch and staring into space.  It's hard for me to unwind.  I can't change that, but I can change how I view outcome.  I am not perfect, no matter how hard I try.  And I'm finally coming to the conclusion that it's all right.

I am the epitome of imperfection.  A few years ago, it would have killed me to admit that.  Now it is freeing.  I am free to embrace my kid's stepmom as a wonderful addition to our lives.  I am free to embrace my true feelings around life situations.  I get mad, I get sad, I get happy.  My children experience this, the messiness of me and my life, whereas before I was a shell of a human being covering up all my emotions.  I think this allows them the freedom to express themselves as well, warts and all.  If I can allow myself to brag on my kids (this is the perfect forum) my daughter is a Duke/TIP scholar in math, an avid late into every night reader, and a creative singer/songwriter who hits the mike running every week at a recording studio.  My son is a math genius (according to his teachers), another avid reader, and carries so much emotional intelligence in the first grade that I get e-mails from his teacher about specific incidences with peers and adults that transform the classroom into a mini-utopia.  But my oh my those siblings can Fight with a capital "F."  And sometimes Cecelia gets into moods that rival the worst teenagers - Ack, at 10 already, who knew?  Sometimes I get ruffled - she is wildly intelligent and preys unconsciously on my weak spots - and yell back.  But we ride it out, and we learn from it.  It makes us closer as a family.

I created all this.  We created this.  The good and the bad.  Me, their dad, their stepmom, all of our extended family and support.  It's not perfect, it's perfectly messy.  But there is something amazing underneath.  Perfection, bah.  Toss it out.  Until you do, you cannot fully embrace life; because life is imperfection.  When you accept that notion, all you Type A MiM's or future MiM's out there - that is when life truly begins.

Guest post: I stopped worrying so much

I’m six months into motherhood and I’ve decided to stop worrying. My husband and I waited until well after residency finished to start a family, mostly to make sure that we were secure in our lives but partially because I know way too much. I was concerned that I would spend what energy I had left worrying about every last thing – did the baby move enough today, did I drink enough water, my feet are swollen and could that mean that my blood pressure is up? During pregnancy I decided to leave all the worrying to my obstetric colleagues (not that there was any worrying to be had – my pregnancy was uneventful and I delivered two days before my due date). After our daughter was born I worried about every last thing. What is that rash? How many times did she poop today? Is she sleeping enough? Can I get all the laundry done today? How will I go out to get diapers if she’s eating for 30 minutes every 90 minutes? Did I eat lunch today? Why hasn’t she started rolling over yet? What if she doesn’t like daycare?

Our darling girl is now six months old. She has turned out just fine despite all my distress and disquiet. I was fortunate enough to be able to exclusively breastfeed her for the first six months. She has had no major illnesses. She is developmentally appropriate. She sleeps through most nights without needing my services. She’s a champion traveler. She enjoys daycare and all the kids there. We have yet to run out of diapers.

I’m making a commitment to worry less. The laundry can wait – it’s more important for me to spend time playing with her while she’s awake. I can fold laundry after she goes to bed. It’s cheaper for me to make my lunch but if I don’t make it to the store because we’re having fun or because it interferes with naptime, then I can buy my lunch. I will worry less the more time I spend with her because it reassures me that we’re all doing fine. We’re alive, we’re breathing. We have a roof over our heads and (sometimes wrinkled) clothing on our backs. When I start to become distressed over something, I stop and remind myself that we’re quite alright. There will be plenty of things for me to obsess over in the future. Right now, I’m going to enjoy my baby girl and how much joy she’s brought to our lives.

Monday, April 22, 2013

MiM Mail: New mom starting residency


I am starting family medicine residency in June when my baby girl will be turning just 6 months old. My husband and I live apart due to his work, but he visits once a week. While I am excited to start residency, I am scared of  babysitting issues (besides the price) as I practically live like a single mother. I suppose I am seeking words of wisdom and encouragement from MiM, as I am afraid of the guilt and afraid of  being bitter about my career choice when facing the fact that I will spend most of my salary to pay someone else to raise my child for 3 years. Can I enjoy motherhood and residency at the same time?

Thank you!

Friday, April 19, 2013

I am getting old....

Last weekend, I took little Mel to a carnival, and BOY did that make me feel old.

I bought an armband to get unlimited rides because, hey, it's a carnival. About sixty seconds after buying the armband, I deeply regretted this decision. I think it was when I watched the passengers on one of the rides careening over my head and I almost threw up. I almost threw up just from watching the ride.

The first ride Mel and I went on was the ferris wheel. That seemed like a safe bet. It just went up and down, no spinning, no turning, nobody on the ride was screaming. But as it turns out, I'm now afraid of heights. When did that happen?

I wanted to keep my feet on the ground after that, so Mel convinced me to go with her into this funhouse. It was very much like this funhouse. However, unlike Olivia Newton-John, I almost killed myself trying to get through the rotating circle. Believe me, there was nothing sexy about my attempts to get through that stupid funhouse. Every time there was a spinning or rotating thing that I could avoid, I tried to do so. And the funhouse ended with a slide. Let's just say that I can't go down a slide anymore without spraining some muscle beginning with "gluteus."

As soon as she got out, Mel said she wanted to go again. I suggested she go herself. And the time after that too.

Next we got to a ride that was called "Optical Illusion." I figured, how bad could this be? It's just an optical illusion! When I got inside, it was just a single stationary walkway where the walls had spinning dots. But nothing was actually moving. Except the second I stepped into the walkway, it literally felt like the universe was rotating. I almost collapsed. I came running out the entrance, saying I couldn't go through with it.

After that, I mostly let Mel go on rides by herself. I noticed at that point that I was the only adult who was dumb enough to buy an armband.

When it was getting time to leave, I told Mel that I'd go on the Tilt a Whirl, because she'd been begging to go and she was scared to go alone. I was almost having a panic attack while we were waiting for the ride, but I kept telling myself it would be okay. Sure enough when we got on the ride, it was a lot of fun. But the second I got off the ride, I wanted to DIE. I was dizzy, nauseous, and I had a splitting headache.

Best of all, Mel still had tons of energy and wanted to ride like ten more things before we left.

I don't get it. When I was a kid, I used to LOVE all those rides. Tilt a Whirl was my favorite! What happened to me??? When did my brain decide that spinning and whirling isn't fun anymore?

Thursday, April 18, 2013

Next topic week: On being an imperfect mother

We mothers in medicine may be very different. We've chosen different specialties, have one child or multiple, have stay-at-home husbands or husbands who travel for work more often than they are at home, are of advanced maternal age or had kids at an age earlier than average, have different ideas of a balanced life. But, I can guarantee we have at least two things in common: 1) we are trying our best for our children; 2) we are not perfect parents.

Our next topic week starting April 29 will be about celebrating our imperfections. (During topic weeks, we feature posts by our regular contributors and guest posts submitted by readers, all centered on a specific topic. During previous topic weeks, we've covered everything from a day in the life to work life balance to childcare.Well, they started as topic days but we realized we had so many posts that we needed to spread them over a week to avoid massive post fatigue.) Posts may cover anything related to being imperfect - confessions, reflections, laugh-with-me-so-I-don't-cry stories, personal philosophies on parenting, you name it. 

We hope you will join in and write something for topic week. To be included, please send your submissions as a Word document attachment to mothersinmedicine(at)gmail(dot)com by April 28. Submissions can be anonymous. For more examples of past topic days/weeks, see Labels in the sidebar.

Thanks for reading and making MiM such an amazing online community.

Wednesday, April 17, 2013

Most Embarrassing Doctor Moments

I'm a tall girl.  Not an amazon (wish!) but a healthy 5'9.5".  So I like the handicapped toilet better than the regular toilets.  I feel like I am sitting on a regular chair, rather than a child's seat.  Much easier to get up afterwards.

Once, about five years ago, I went to the bathroom at work.  Stopped in a public hallway one on the way to a thyroid needle in another building.  Walked straight back to the handicapped stall and got situated.  All of a sudden I heard someone speak.  "It's ok Mom, just try to hold it.  The stall is occupied.  I am sure they will be out soon.  Sorry for your wait."  I looked down through the gap under the bathroom door and saw wheels.  I was mortified.

I quickly attended to my business, all the while sweating and stressing.  Not only was I an able bodied, ambulatory individual, I also had my doctor's coat on.  I flushed, got dressed, and decided no way in heck could I walk out wearing that coat.  I took it off, rolled it up, and stuffed it underneath my armpit.  Took a deep breath, opened the door, and muttered my apologies as I escaped the bathroom to my needle.

I am still guilty of using the handicapped stall in restaurants, but not until after I have cased the area for those who might need it for reasons other than comfort.  I have not since used the handicapped stall at my hospital, despite never having seen another wheelchair in that particular bathroom in the last five years.

Monday, April 15, 2013

MiM Mail: College freshman fears

Dear MiM:

I am about to finish my freshman year of college and have started to second guess my dreams of becoming a doctor. I know, it's early, but each step I take now is one step closer to my future. It's somewhat silly, and I have so much time, but my fears are haunting me:

1) Prerequisites for med school: I have yet to take chemistry at a college level. I am terrible at math and chemistry and fear that I don't have what it takes to even make it to med school (or in med school)
2) Nausea: I have somewhat of a weak stomach and am concerned about certain rounds. I know it's part of the job, but not EVERY job, right? Fainting or throwing up is probably not received well.
3) I am 100% positive that I am currently dating the man I will marry. Which means that marriage will come right before med school (and grad school for him) and, more than likely, babies to follow. I know that you women do it everyday, but it seems so daunting. Especially since we will more than likely have to move away from our families in order to both be able to attend a school in the same town. But on the flip side, I don't want to wait forever to have children, and even waiting until my early 30's seems too long to wait for my desire for a large family.

Thank you for reading this and attempting to ease a potential MiM's fears. Likewise, if you truly think I should not be in medicine due to any part of this, please be honest.

Saturday, April 13, 2013

When shared parenting means you are no longer number one

Recently, my daughter went through a period of preferring my partner, her other parent. For about a week, I would come home from work, starved for time with her,  and she would run to my partner and make a big show of hugging her and demanding to go into the kitchen with her. At dinner time, she refused to be fed by me, accepting food only from my partner, her Baba. At bathtime, I would have to pry her from her Baba and endure her bitter tears as we trudged upstairs for what is usually our most joyful time together. I was on a particularly miserable month, working the longest days I've worked all year and feeling resentful, bitter, and guilty almost every waking moment because I was spending so little time with her. When this theater of cruel preference happened for the first time, I went upstairs, turned on the bathroom faucet, sat on the tile floor, and sobbed for fifteen mintues. Then I came downstairs and tried to be as cheerful as possible as I sat next to the high chair and watched dinner progress without my participation. The situation was no fun for my partner either, as my time at home is the rare window of relief when she can check her email and recede into her own mental world for a while. Only E seemed to be having a ball, cocking her head to one side and making flirty toddler eyes at my partner while pushing my hand away from the food on her tray.

A male colleague once complained to me that his son prefers his wife, even to the extent of screaming and pushing him away when he goes to to pick him up in the morning or comfort him at night. As he told me this, I'm ashamed to admit that I thought, "Well she is his mother," as if motherhood is synonymous with being a child's primary go-to, as if a father should be resigned to being second pick. Well, here I was faced with the same situation and I was not resigned. 

I am not my child's primary caregiver. As an intern, I work until 6pm on the best days which are few, 7pm on most days, and 9pm on the worst days which happen at least 1-2 times per week. I have a week each month where I am gone from 6pm - 9am six nights in a row. The rest of the time I leave the house before my child wakes up and then I do bath and bedtime whenever I can, which is 3-4 days per week. Every day I have off, every evening hour that can be squeezed from the stone, every hour I can delay going to sleep post call, I do, but it still doesn't add up to 50%. Not even close. So I am not my child's primary caregiver, but up until the aforementioned week, I was pretty sure I was her go-to, her first draft pick. After all, I carried her and birthed her and nursed her and I am the only one in this family who takes rectal temperatures, let the record show. Prior to this episode, she had always been pretty happy with either or both of us, absorbing the love and care and attention of whichever of us was available at the time, so the assumption I had made about my being somehow more sacred and important had never been tested.

It was not a pleasant situation. In fact "My child will prefer her other parent" is probably number 2 on my list of top fears about being a working mother, right after "My child will be maimed or die while in someone else's care." I googled "My child prefers her other parent" and discovered that this happens to lots of people. Some children prefer their working-outside-the-home parent to their working-in-the-home parent and for some it is the other way around. In families where both parents work, the preference cannot be so easily explained away. Sometimes the preference is temporary and sometimes it is more deeply ingrained. In families with multiple children, one child might prefer one parent while another child prefers the other parent. None of these preferences seem to fall easily along gender lines. It was comforting to read post after post about this problem, but none really addressed my fear which was that by working so much, I was losing the right to be my child's number one. (Of note, I encountered not one post from a man complaining about this. Do men just not post on online parenting forums? Is this something that does not disturb them? It's an interesting question.)

When I was forced to examine my need to be number one, I realized that the whole construct is flawed and not relevant to our family. I was our daughter's primary caregiver for the first six months while my partner finished graduate school, now she is the primary caregiver while I am in residency. We have divided the work of parenting in a way that feels natural to us and that has nothing to do with traditional divisions of labor. My partner cooks. I deal with illnesses and sleep. We both work and make money, though my job is currently more time-intensive and less flexible. I'm good at helping our daughter achieve developmental milestones, my partner is good at structuring her days and giving her the downtime she needs. My daughter has two parents who work cooperatively to meet her needs and I'm very proud of that.

I'm not going to pretend that this transition in my thinking has been seamless or complete. There are still moments of panic and jealousy that my partner is so much more present in my daughter's life, for now. Thankfully, the phase passed and my daughter is back to taking the love from wherever it cometh, but I can't deny that I am secretly pleased and relieved when she leaps ecstatically from my partner's arms to mine when I come home. But I am teaching myself to be just as happy when she leaps from me to my partner, because the net of safety and love that protects her is so much stronger than it would be if she were relying on only one person to meet her needs. If I weren't working so much, things might have played out very differently in the dynamics of our family, so in a way I'm glad that necessity has created the opportunity for a more shared model to evolve. Ok, I'm not glad. But I do think some good has come of it.

Wednesday, April 10, 2013

Muffin tops, belly jiggles, and other mommy "war scars"

Zo will be 2 years old in a few months. I was very healthy prior to and during pregnancy; I regularly did prenatal yoga videos, walked daily, and even did Zumba until I was 5 months pregnant. Sometime during my 8th month, I developed an abdominal hernia. I knew it needed to be assessed, so 8 weeks post partum, I went to see one of my favorite Professors. He is a round-bellied, wonderfully abrasive Surgeon with a penchant for throwing things in the Operating Room. He’s a no-nonsense type of guy with a plethora of jokes and a desk with an ample candy jar. He is an excellent Surgeon and his patients love him, and I guess at the end of the day that’s the important part.

During my appointment, he examined my hernia and said “just wait until you pop another one out before doing anything with this.” I asked about the extra flub and stretch marks and he said “give yourself a year, things should tighten up by then”.

18 months into the game and although I dropped the baby weight quickly (another perk of nonstop breastfeeding, a healthy diet, and frequent stroller walks), these muffin-top-wiggle-jiggle and hip flub-shakes just does not want to budge. My various corsets and girdles help to camouflage it when I want to appear shapely, but nothing helps when I am naked or even worse when I am at my beloved Zumba class shaking it up in workout gear with all of the skinny-minis.

I started working out again (ie, getting in a once a week Zumba class or some core strengthening training on Youtube while Zo is asleep) a few months ago. I looked at my bulging belly and hips and cringed. O is happy that I no longer look as malnourished as I did between 4 to 6 months of nursing, but neither of us loves the extra jiggles and low self esteem that come with them. I began to understand how folks slowly become overweight and out of shape. It’s like a slow decay creeping in. One day you skip a workout and then a few weeks later you realize you haven’t worked out since God-knows-when. You see your morphing shape and think (through my Pediatrician’s lens), I am soo tired, who has time to work out when I am trying to feed my family and cuddle my baby before going back into the NICU to keep really sick babies alive?!?

But it is important. And I do have to make time. I realized during undergrad that I need to work out. My body, mind, and spirit need it. When I am in shape and feeling good about my body, it is amazing. When I don’t exercise I feel downright yucky. Add replacing my beloved six-pack abs with this stretch-marked-middle-jiggle and you get the picture. Folks (my mother) who have seen the immediate post-partum belly and what I have now say it’s not soo bad, but to me it is.

I have vowed to continue to shake my mommy-bulge at Zumba and try to step up my efforts. I am planning on tightening up what I have so that I can feel better about the new mommy-me. These are my war scars. I’m in the trenches. Mommy-pouch boot camp begins now!!!

Monday, April 8, 2013

MiM Mail: Didn't see this coming

Dear MiM,

I've been following your posts since before I began Medical school!  I'm currently an M3, my journey has been far from traditional.  I put my medical school dreams aside after college to help out at home and take care of my mother.  Fast forward many years and I began my medical school career at 33 as a daughter, wife and mother of two gorgeous little girls (5 and 2 at the time).  It has been a lonnnnnng road needless to say.  Just three years later, I face M4 year and residency as a single mother of two living back home with my mother.  The ex's insecurities (non-medical) and later infidelity became too much to bear.  Although, he is a phenomenal father - very hands on and picks up a lot of the slack.

So, to my current state! I'm two clerkships shy of completing 3rd year and have yet to find my "calling."  I absolutely loved OB and I keep saying if I were single and 10 years younger, I would totally do it.  I love EM, but do I really want to put the girls through not having their mom so much at nights, weekends and holidays? I felt as if FM didn't get the respect that they deserved, and going through one more day of rounds in IM would have been the end of me! Psych, so help me God, if I fell for one more drug addict's story, I was going to institutionalize myself.  Peds left a sour taste in my mouth due to the company....

So now what!? I apologize if I offend anyone, I'm just trying to be honest and show you a glimpse of the million things in my brain.  I need to be moving, I love variety, and I'm a hard worker! But let me be honest to myself! I'm 36 and I'll be almost 500K in debt when we graduate! What's going to pay the bills, provide my daughters with a mother, and allow me to be a great physician?

After residency is over, my oldest will be 12 and youngest 10. So much time they and I have sacrificed and for what!? For their mother to have no clue how she's going to move forward alone and completely in debt? Did I mention the divorce lawyer said I'm confined to my state for residency or risk losing the girls? As if finding a residency wasn't hard enough.

I just need advice. I have no idea what to do.  I've kept it together this long and now the pressure to make a decision on a career seems to be putting me over the edge.  I just didn't know the amount of sacrifice medical school would entail.  I know there is always light at the end of the tunnel...but at this point I would have never done this had I known. Obviously my love for the field was more than my love for my marriage because I chose medicine over it. The question now is: how do I make all the sacrifice pay off?   I need direction and I can't talk to my 26 yo single friends who make it seem so simple.  For them with no responsibilities, it is!  At this point I just feel like I've been a completely selfish person having decided to ever pursue this and I feel obligated to pick a field that will help me start repaying my time lost with the girls.  Is that even possible?

Selfish Mommy

Sunday, April 7, 2013

Part-time Residency

Apparently, some residency programs lately, notably in pediatrics, have been offering the opportunity to do residency part-time. According to a Newsweek story, about a quarter of pediatrics programs nationally offer this option. It sounds like the programs may offer reduced call schedule and months off, all with a prorated salary.

If anyone who has done a part-time residency wants to weigh in on this option and what it's been like for you, then that would be great. But according to the article, hardly anyone does it.

Considering a lot of pediatrics residents have children during residency and then choose to work part-time after graduation, it seems like this would be an option more people would choose. Granted, it does extend residency about about 15 months and who wants to be a resident for an extra year? Still, what's an extra year, really?

The article hypothesizes that women don't choose this option because they want to be taken seriously. We don't want to be labeled as the part-timer and have that follow us our entire career. I've noticed a general theme in medicine that women often don't want to be granted exceptions because we want to be equals. Yet.... do we wanted to be treated as equals? Yes, we want to be treated with an equal amount of respect, but I personally feel like we're not equal. So I'm not sure if I want to be treated just like a man.

If there had been a part-time option in my residency, I don't think I would have taken it. It probably depends what it would have entailed. We didn't have a heavy call schedule and the days weren't long, so the only thing they could have offered me would have been blocks of time off, and I'm not sure how much that would have helped me.

Saturday, April 6, 2013

Motherhood changes you: cooking and hair braiding

This is not a story of the profound and amazing ways that motherhood changes you.  Its about two simple ways that it has changed me.

Before I had my daughter I had NO domestic capabilities.  I could read directions from a cookbook but my husband was the adventurous one in the kitchen.  Also, despite having a lot of hair, I was completely incapable of controlling it!  When my family members found out I was having a girl, after the congratulations many of them laughed at me and said they felt sorry for my future child and the ridiculous hair she was bound to have!  However, on this almost last day of my vacation I find myself cleaning the kitchen to prepare for tonights culinary adventure and tonight I will engage in a hair-braiding adventure with my beautiful girl in order to be ready for church tomorrow.

My daughter LOVES food.  She is the smallest child in her daycare class but requires two breakfasts in addition to the one dad gives her on the way to school, gets a double portion of lunch and eats two snacks and an adult portion of dinner.  She is a rail thin ball of energy.  She devours everything I make. She smiles and licks her lips and yells things like "SO GOOD MOMMIE!!!!  YUMMY IN MY TUMMY" and my favorite, "I LUB IT!!!!!!"  She loves all the different cuisines I try, Spanish food, Indian dishes, Caribbean dishes, attempts at French cuisine - and it just fuels me to cook more and more.  Thanks to the Pioneer Woman and my Le Creuset pot (a gift because there's no way I could afford one), I am a cooking machine.  My mom gave me a recipe book of family dishes at my bridal shower, I had barely touched it before my daughter was born, and now I use it once a week and I've added a few dishes of my own.  With my busy schedule its something I enjoy and can share with my daughter and provides her with meals even when I'm away from home.  Motherhood made cooking about love.

My baby girl was born with a head FULL of hair.  At two she has a beautiful head full of soft curly hair that stretches down her back.  My husbands hair wrangling abilities are measly at best so I needed a way for her to get to daycare looking un-hobo-ish in my absence.  So with the help of wikipedia and my dads response to my mom mentioning my hair braiding insufficiencies that "She can do anything she wants to do, no reason it will be any different with hair braiding" - I decided to figure it out!  Now each night after bathtime, we sit and watch Dora and I braid like crazy.  I treasure this time with my baby and when I'm done I tell her to go show daddy her "princess hair" (everything must be princess something right now).  She smiles so big and touches her hair and runs to the mirror.  All love.

Friday, April 5, 2013

What Would You Do: An Encounter At The Playground

So I had some free time on a lovely Saturday morning a few weeks ago. I wasn't on call, and I had no major errands to do. Babygirl was due for her nap, so I left her with her dad, and took Babyboy out in the jogger stroller, to the playground.

The playground is very large, with a baseball field, a grassy stretch, and several sets of gym equipment, slides, swings, and a sandbox. Babyboy always aims right for the sandbox.

There was a dad there, with two kids, a boy about 4 years old, and a toddler girl. The boy was doing his own thing, digging under the swings, and the dad was following the toddler around. We didn't interact really, except when Babyboy ran over and grabbed one of the boy's shovels and took it back to the sandbox. The boy didn't seem to notice; I apologised; and the dad nodded that that was fine.

I was sort of playing with Babyboy and sort of spacing out for awhile. It was a clear, sunny day. I heard the Dad say something like, "Son, your sister needs a diaper change, so I'm going to go do that, alright?" I figured he must have brought a diaper bag.

Some time later, I idly turned towards where they had all been, and there was only the boy, still digging under the swings. The dad was off in the distance, carrying the toddler girl,  probably a good football field's length of distance away. I watched as he kept going, down the road, up the stairs to a house, inside, and shut the door. He never even looked back.

Now, this is a big playground, with parallel fences on two sides, and parallel roads on two sides. The road entrances are not gated, they are open to traffic. One of the roads is heavily traveled. It would never occur to me in a million years to leave any age child unattended there.

Though the little boy didn't seem worried that his dad had taken off, he did suddenly seem to notice us. He saw me watching him and smiled. I felt terrible for him, being left alone like that. I felt responsible. I smiled back and called over to him: "Hey, want to play in the sandbox too?"

He got up and ran to us, happily, and both boys dug in the sand, not really interacting. Then he hopped up and ran to the slide, and went down a few times, running around it and giggling. Babyboy was taken by this. Babyboy doesn't seem to like slides much, but is fascinated when other people go down them. The kid kept running around and Babyboy watched.

I thought about this dad leaving his kid alone in the playground. He didn't even ask me if I was willing/ able to watch his kid for a few minutes. What if he had? I would have said yes, but I would have felt a bit put out. We weren't planning on staying there forever. Also, he didn't even know aything about me. He didn't know I was a responsible physician. I could be a kidnapper. Or just irresponsible, and leave the kid totally alone.

I thought all of this, and wondered if I would say anything when (and if) the dad ever got back.

Then, after a total of about ten minutes, the dad reappeared at the far edge of the playground, with the daughter. But they didn't come right back to where they had been. They dawdled way on the other side, while she toddled around on the grassy area.

Meantime I was kind of annoyed. Babyboy and the abandoned boy were sort of digging in tandem. Babyboy kept grabbing things from him though, and he was getting feisty. I kind of needed the dad to moderate.

As soon as he came close enough I planned to pack it up. He did walk over, calling to his son that it was time to go.

I didn't say anything.

What would you do?

Tuesday, April 2, 2013

1 step foward, 2 steps back

My husband and I went on our first vacation sans bebe. It was magical. Nestled in the hills of a Midwestern state, we drank lots of wine, watched tons of movies, got a couples’ massage, and even managed to do some work.

At 2am the day before heading home, we received a frantic phone call from Zo’s grandfather (my father) and our babysitter while we were gone. Zo had a fever, to 102! Granddad was ready to head to the ER. Vacation-mode-mama put her momma-doctor hat back on. Triage mode: he was indeed fine (eating, drinking, pooping, peeing) and most likely just had viral upper respiratory symptoms. Watch and wait I told Granddad. We okayed foregoing fitful sleeping in his pack-and-play for cosleeping and Zo happily snuggled with Granddad until breakfast.

Flash forward to our return. Zo was a febrile, coughing, sneezing, whining fussy-fuss-face with 2 molars and 4 teeth coming in. We returned to purgatory and Granddad went guiltily back to Grandma. Our week went like this: waking 5 times a night for cuddling because self settling just would not do, alternating ibuprofen and acetaminophen, a trip to the Pediatrician for an ear, throat, and lung check, and finally the dreaded call from daycare “Zo is fussy and has a fever, please come get him.”

And every day he kept having fevers so he ended up out of daycare for an entire week. The gains O and I had made in sleep and patience quickly evaporated and now we are back to a little one who wakes up multiple times throughout the night to be consoled. What is this behavior?!? Who is this tyrant? Not to mention we ended up in the Emergency Room at 3am (post to come). Our week was one of my most difficult of Intern Year in spite of being after a 5 day vacation while on an elective; 1 step forward, many many many steps back.

I start a week of nights tonight and O will be on his own. Fingers crossed and prayers uttered that Zo gets with the program and begins sleeping through the night again. We are soo very tired but Zo has made it successfully through his first day back at daycare.

**** Shout out to Fizzy for your timely post entitled “Need a Vacation”. Vacations are work and I’m not sure if they are worth it at this point either ****

Monday, April 1, 2013

MiM Mail: Delay fellowship?

Hello! Longtime reader here! I am a third year Medicine resident at a notoriously grueling program in the southwest (which I love and would choose a thousand times over if I had to do my Match again...) on the brink of finishing my residency. I am heading into a Chief Resident year which should be a nice break - at my program we are junior faculty, paid as such but only attend for two months and have 10 months of administrative and educational work. I am mom to one lovely 9 week old baby girl. My husband is not in medicine and is currently a stay-at-home dad. I'm struggling in my decision of when and whether to pursue fellowship, and here's why...

As an intern I fell in love with critical care. I loved the fast pace, the gratification of seeing a septic shock patient turn around in hours, loved working with a big team of folks to bring someone back to health. I even liked the end of life issues and family discussions. I liked the idea that even when I had nothing in the way of medical treatments to offer I could still help the patient (and more often, the intubated/sedated patient's family) come to terms with the end of life. I did a block of Pulmonary Consult at our large tertiary referral center and found the physiology and multisystem diseases that involve the lungs very interesting as well.

I'm not sure what happened this year - if I just got tired and burned out (we have 4 ICU blocks a year, still have 30h resident call q4, minimal outpatient stuff) - but I grew tired of the same old thing in the ICU. I got annoyed when families wanted their 85 year old grandfather with two primary cancers and septic shock to be a full code. I got tired of the overdoses and alcoholics in DTs we see at our county hospital coming in night after night, their self destructive behavior the reason for thousands of our taxpayer dollars being spent to dry them out, extubate them, and discharge them to homeless shelters or broken homes to continue their substance abuse. Even some of the pulmonary sub-specialty patients started to annoy me; most of them are in and out of the hospital frequently and have been sick all their lives with congenital heart and/or lung disease and have the "sick person" mentality.

After slogging through months of call while pregnant and finally having my baby girl here with me - the thought of heading into fellowship after my Chief year makes my stomach turn. I am so tired of being a resident! The toddler inside me is stomping her feet and wants to be the BOSS already and stop having to run everything by an attending all the time. I'm tired of 80 hour work weeks. I'm exhausted.

I am considering taking a year to work as a hospitalist and consider my options. On one hand - hospital medicine pays enough for us to live comfortably, in my opinion (I did not grow up with much and neither did my husband) and the moonlighting opportunities in my area would enable me to very easily make an extra $50K by working three very easy nights a month. Scraping along on $50K as a fellow for three more years makes me feel sick...and we want more kids - it would be way easier to do that as a hospitalist than a fellow in a program with 3 or 4 fellows per year.

On the other hand - in my heart of hearts I fear general hospital medicine will not be enough for me. I want to be a specialist - someone who is consulted to assist with a sick and complicated patient. I like pulmonary medicine and while I would probably not do critical care full time or even half time, I wouldn't mind keeping a toe in the water in an academic Pulm/CC position - a few consult months, a few inpatient ICU months, etc. I can't imagine doing any other fellowship really...so if I do specialize, I think Pulm/CC is it for me. And I fear if I go the hospitalist route I will never go back to do my fellowship.

Any ideas? Is it better to do fellowship now when my kid(s) are young? Should I just gut it out a few more years and get through it? If I wait to do fellowship, my kid(s) will be older - won't they miss me more? But I can't stomach the thought of doing a fellowship now. Would love to hear the perspective of you brilliant ladies :)