Monday, May 27, 2013

MiM Mail: Where now?

Dear MiM,

I am so grateful that I have come across this community. I have now spent many, many hours putting my 20m old to sleep and then lying in darkness and reading your posts on my iPhone.

So, I thought I would ask for some advice....

I am 35 yr old Intern and mother of 3 boys, aged 6y, 4y and 20m. I live in Australia and have been very lucky, thus far, with balancing work and family. I was able to do most of my internship part-time with two 10-week terms of full time work.

I LOVED my part time work. I had time for my boys, I could help at my son's school, I had time to read up on topics in medicine that interested me (or I needed to brush up on), I found some time to sew (my creative outlet). Ironically, I also felt that I was a better doctor - when I was at work my heart was really in it.

I am now in week 8 of one of my full time terms and I am tired, cranky, my house is falling apart, my 4yo is waking up in the middle of the night and coming to check if I am around, my 20m old is glued to me from the moment I walk in the door, I barely know what my 6yo is up to at school.... At work, as the afternoon slips away I catch myself checking the clock and trying to speed through the jobs. I am way too tired to read anyting medical. My sewing machine is collecting dust.

And, I have to make up my mind as to where from here. In Australia, we have 2 general hospital years (Internship and Residency) before we decide what to do with our careers. In a few months time I will need to make some decisions.

I went to medical school thinking that I would do O&G. However, I realised that I was a lot more 'natural birth' camp (my 3rd child was born at home) than medical intervention - which was not really compatible with O&G culture here. Also, I was not prepared to work the hours this specialty requires.

So, what is left:

Option 1 - Anaesthetics. I like the 'doer' aspect of it, I would love to have all that knowledge of physiology, I like the science of it, I love being organised, I like putting lines in, I like OR, I like that at the end of my training I would be able to control my hours and that part time is a real option here. BUT I would need to put in at least 3-4 years of full time work (and how will I cope if I am a mess after 8 weeks of full time?). Getting on the training program is difficult; it is very competitive. I have some advantages - I have a PhD (in Molecular Biology) and research background.

Option 2 - Family medicine (or, as we call it, General Practice). What appeals is the possibility of doing a lot of women's and children's health (I love this aspect of Medicine). I would love to do a Diploma of Children's health and Diploma of O&G which could focus my FM practice a bit. I could also easily train part time. But, will I get bored (I do not like office that much), will I end up in some 'sausage factory' medical centre, will I ever be able to focus my practice to the areas that I like. There is a fair bit of discontent amongst FM doctors here - about mountains of paperwork they are expected to do, about poor pay, about pressure to 'churn' patients through... Will I become bitter?

I should also mention that my husband works full time and has a very busy job with fair amount of traveling. He is supportive of whatever career choice I make but ultimately I am the primary carer of our boys.

I am now obsessed with making a choice, chosing a path, getting settled onto something. I cycle through these options many times a day, and it all seems like a big Rubic's cube to me - I line up one side just to find out that the others are not in order.

Dear MiMs could you please give me some advice?

Dr Mum & 3 boys

Thursday, May 23, 2013

Guest post: Choosing part-time work in emergency medicine

First I want to tell you all how grateful I am to have found your site.  I now check it regularly and see it as my "lifeline" to others who have been through (and are going through) a lot of my own struggles and joys of being both a mom and a doctor.   I am a part-time practicing Emergency Physician 6 years out of residency.  I live in the Midwest.  I have two children, a 9 year old girl and a 4 year old boy.

For a while now I have been wanting to write something about choosing to work part-time.  I have been inspired by all the great posts from the other MiMs, so here is mine:

I am a part-time ER doc.  It is something that has taken me a while to feel proud to admit.   I love being an Emergency Physician, and I know that there is nothing else in the world I'd rather (and am meant to) do.  BUT....I am also a mom.  I had my daughter right before intern year started, and nothing could have prepared me for that experience.  I think I must have deluded myself in thinking that it would somehow be doable to juggle the responsibilities of both a newborn and intern year.  Without my husband it would have been impossible. I missed out on so many moments with my daughter during her first few years!  Do I regret this?  I guess in a way I do, but I know that if I didn't miss out on those moments I would not have been able to succeed in this career I love, and would not be able to support my family financially as I do now.  I want to tell all you other MiMs out there--nine years later, my daughter has NO recollection of the first 3 years of her life, she has NO idea that I was gone for most of those years, and despite all those missed moments we have a very close relationship. 

I started working full time after residency to pay off debt and our mortgage, but I cut down to 80% when my son was born.  This has allowed me to continue to support my family and enjoy our life by going on vacations, going out to eat, and spending time as a family.  But after a few years the time had come to decrease my hours even more.  Being in EM for so many years has taught me one thing:  life is short, and you never know when it is your time--time to get sick, time to become injured, time to die.  I know that there is a lot of controversy and stigma out there about "part-time docs", but in the end this is a personal, not a socioeconomic decision.  I have dedicated 13 years of my life to medicine.  After 3 years of residency and 6 years of practice I am confident in my skills and knowledge.  It is now my children's turn to have my focus and attention. They will only be this small and will need me this much for so long.  It is their time.

Monday, May 20, 2013

MiM Mail: Pregnant and joining a new practice


I've stumbled across this page from time to time and have found it very supportive and informative.

I am a soon-to-be graduating neonatology fellow in the south.  I have one son who is almost a year and a half.  I am married to a very supportive, non-medicine type husband.

A few months ago, I accepted my first position as an attending in a private practice, community hospital setting to start a month after I graduate from fellowship.  I just recently found out that I am 7 weeks pregnant with our second child.  While my first emotions were excitement and joy, very shortly after came apprehension and guilt about joining a new practice while pregnant.  I am know I am not the first, and will certainly not be the last, to be in this position but I would like to hear from other moms in medicine about their experiences with this.  When should I tell my new practice that I am pregnant?  As soon as possible or just show up to work 20 weeks pregnant and tell them then?  How and when should I broach the subject of the length of maternity leave?  I would really appreciate any advise or insight from other moms in medicine.


Friday, May 17, 2013

Don't Trust Me, I'm a Doctor

Yesterday I got coverage to go to my kid's school to bring birthday treats - they are celebrating Summer birthdays before the end of the year, and Jack turns 8 on June 3.

I stopped at the hospital gift shop on the way out and bought a beautiful balloon, a "double bubble," it had clear plastic surrounding a pretty pink flower with a purple and blue butterfly on top.  The effect, I thought, was breathtaking and I couldn't wait to share it with Jack's class.  I considered sending the treats with him and skipping the class party in the interest of my large workload, but that morning at breakfast Jack asked eagerly but guarded if I thought I could make it so I determined that even if it meant staying late at work, I would.  He was thrilled.

It was raining cats and dogs when I pulled into the school parking lot at 9:35 - designated time was 9:45, so I covered the treats with my yoga mat and darted in the double doors briskly.  I stopped to check in with the secretary.

"I'm just going to bring these treats for Jack's birthday celebration."

"What are they, do they have nuts?"

"Um, I don't think so - we've been eating them for years.  My kids hate nuts, and it's a fave, but I've never asked the bakery.  I got them from Sweet Love - they are called Ninja Turtles.  They are condensed cookie dough around homemade caramel with chocolate drizzled on top, they are amazing."

"Oh, never mind, I think the kid with bad nut allergies is in the other class.  But I'm going to have to ask you to take the balloon to your car.  It's a choking hazard.  I had to turn away a Mom bringing 18 balloons to the class the other day."

I looked at her perplexed.  "I'm so sorry, I had no idea."  She softened.  "Well, if you just bring it for the party, then take it back to your car, I guess it's ok, just the one."

"Oh thank you, I promise I'll do that."

I walked into the classroom with the box of treats.  The teacher introduced me, Jack gave me a hug.  She then said, "Do those have nuts?"

"I don't think so, but I've never asked.  My kids hate nuts."  The teacher pointed to a kid with nut allergies, the first kid that my son was excitedly indulging with treats.  I watched him take a big bite.  Jack finished passing out all the Ninja Turtles, and gave one to his teacher.  The children were munching happily; Jack was on Cloud Nine.

The teacher walked over to me.  "Can I see another one of those?"  I mistook her mood - thinking she loved them so much she wanted another.  She started dissecting the Ninja Turtle.  "I think these have nuts in them.  I got that nut caught in the tooth sensation."  I told her, "I'll call the bakery and find out for sure."  The baker confirmed a small amount of crushed pecans, and I relayed silently to the teacher in alarm.  She walked over to the boy with the allergy.

"I'll need to take you to the nurse."  He protested, saying that nothing was happening, while I reeled in horror but assured her that I would watch the classroom while she left.  I was in scrubs, pager on my hip, wishing I was back in my office at my scope, but worried about the kid.

I was at the helm, and I did well.  Another boy stood up, announcing his nut allergy.  Luckily he had already done this earlier and I watched the teacher artfully blow him off, so I didn't have a heart attack on the spot.  I asked him, "What happens to you when you eat nuts?"

"The tips of my ears turn bright red."

"Well, that is not happening right now, but I'll be sure to be on the lookout for it."  He smiled and sat down.  Most kids were simply alarmed that they had enjoyed a treat that contained hidden nuts.  Jack said, "I've never had any idea that these had nuts!"

I entertained the kids by showing them a picture, one by one at their tables of a wax couple - Queen and King of Hearts, that made Jack laugh so hard the other weekend I thought he was going to explode.  Got similar laughters from the children.  It was fun and calming.

The teacher returned, apologetically.  "I'm sorry it was my fault, I should have checked into it more.  He is in a nut challenge study and is building up his resistance, so this is probably a good test for him.  His nut allergy is not that bad.  It will be OK."  Whew.  I melted with relief inside and resolved to text the mom, who I knew, who was equally relaxed in return texts.  Note to self - No more Ninja Turtles at the school.

The teacher also said, "I can't believe you even came, you're a doctor!"  I embarrassingly replied, "Yes, so you trusted me, about the nuts.  Because I'm a doctor!  That makes it even worse."  She laughed.

As I drove back to work I realized I had left the balloon in the classroom in my tizzy and called the school to tell them.  The secretary said, "Thank you so much for calling.  I'll run get it out of there right away."  I imagined my beautiful balloon as a menacing creature in disguise, exploding into tiny suffocating bits that were about to fly directly into each child's larynx, creating mass chaos and asphyxiation.  I hoped she would get there in time.

It was hard for me to get back to work - the experience was so traumatizing.  I texted my friend about it, "I think they might call me in on the child abuse hotline.  Next birthday I guess I'll just bring a carton of cigarettes and a case of beer.  I've set an awful precedent.  I'm THAT mom."  He and my partners empathized and laughed.  "You're experience is so 2013.  So different from when we were growing up."

I recall back when my kids were 3 and 5, at Montessori School, I had a rare fit of baking resulting in peanut butter balls.  I used the wrong chocolate that melted at room temp.  I proudly brought them to school, freshly refrigerated, only to be turned away with consolation and mild reproach.  "This is a peanut-free school, remember?"  Fail.  It was winter, temps in the 20's and 30's, so I kept the peanut butter balls with chocolate that needed to be refrigerated in my car passenger seat, and ate them all over a week.  You'd have thought I learned my lesson.

I hope to in no way belittle the seriousness of peanut allergies by this post.  It served to remind me of the importance of checking in on ingredients.  We are baking a tres leche cake this weekend for a Spanish project for my daughter Cecelia, and I checked and double checked the ingredients as there is a serious nut allergy kid in her class. But I am a nut hound, and I forget.  If you look in my office food drawer right now you would find almonds, pistachios, and pecans.  I apologize for any perceived but not intended insensitivity and understand the seriousness of the topic, but found the incident today quite amusing, with a luckily happy ending.  Here's to the King and Queen of Hearts.  Who look as alarmed and upset as I did, when I found out about the hidden nuts.

Thursday, May 16, 2013

Guest post: Maternity leave, or lack thereof

I am a psychiatry intern currently about to have my first baby towards the beginning of my second year.  I feel so blessed to have this baby, who we recently found out is a girl.  I am not the emotional pregnant lady everyone speaks of--just so so happy about our family's future.  It took me a long time to decide to do psychiatry, and when I wasn't sure if I would have kids in residency, I thought of ob-gyn.  Now, seeing how accepting and supportive my program has been of my pregnancy, I am happy with my decision.

But, there are a few things they can't change, and they have made that clear to me.  For example, if I want to fast-track into child psychiatry, which I do wish to do as the fourth year curriculum at my program isn't ideal, I absolutely cannot take more than 35 days off during my second year.  This includes all vacation and sick time.  After some deliberation with the program director, we have come to decide that I will be taking my four weeks of vacation, plus 10 days sick time, to make a total of 6 weeks maternity leave.  This leaves me with 5 days of baby sick time or emergencies for the entire remainder of my second year.

While I am okay with this scenario, and actually it's more than I expected to have in residency, I grow more and more bitter towards the field of medicine.  Family and friends are always so shocked when they hear about the above "maternity leave."  My friends in finance always fire back with, "What! So-and-so at my job got pregnant and had 4 months paid maternity leave, without using vacation."  Gosh, wouldn't that be so nice.  When MIL heard about the maternity leave, she couldn't believe it.  Her response was, "But that's not fair!"  Who's to decide what's fair?

I am beginning to think more and more about simply extending the residency and doing a fourth year as much as I don't want to.  It's an easy call free year and I may like to have the time to spend with my little daughter.  However, with looming debt over our heads, I would really like to be able to make an attending salary sooner.

Some that read this post may think, "Wow you are lucky, that is a great amount of time!"  But I don't feel lucky to have to pass my baby on at 6 weeks.  I don't feel lucky that I'll be taking a lot of call while my baby is an infant.  Or that after much hard work, I still have to squeeze pennies to buy baby stuff.

Does anybody else agree that medicine just sucks for motherhood?

Wednesday, May 15, 2013

And many more

In honor of Mother's Day, I was interviewed for Radio Rounds about Mothers in Medicine - why it was started, how it's grown, and whether I thought mothers in medicine could "have it all." (An enthusiastic Yes.)

Mothers in Medicine will turn five this month - 5 years of stories from amazing women who I am honored to write with and share this space. Some have been writing here from Day 1; others have joined in along the way. All have shared openly, these thoughts and feelings that could easily be kept private, for the benefit of this community. The blog's growth has been staggering.

This blog is still my favorite "extracurricular." I list it on my CV under "Service to the Community" because I think that's what it is: service. It's community. A labor of love. And definitely, not a business (note: we do not, nor will we ever have ads. Advertisers, please stop emailing.).

So, MiM writers, thanks for writing. You are all fantastic, and I still hope for the day that we'll hold a MiM conference somewhere tropical. I'm buying you all drinks. MiM readers, thanks for reading and commenting and liking and sharing. You're why we are all here.

To 5 years and to many more.

Tuesday, May 14, 2013

in the thick

I've been to urgent care three times in five days with two sick kids, one of whom almost got hospitalized for pneumonia.

A few days ago we put an offer on a house (our first ever), for which the payments would stretch us fairly thin during the six months until I start work post fellowship. 

I've signed a job contract that I had planned to mail yesterday. Just before dropping it off, I received one email and one text message, both in regards to two different job opportunities.  I have one week before this contract is due and, even though the other two leads might be better fits for me and my family, the contract I have now is not sometime I would want to walk away from. One of the leads is in another state, further complicating that home offer we made.

It's a strange week when patient care is the least stressful part of my day.

Monday, May 13, 2013

General Practice Pathology

This post is dedicated to an amazing clinician, MomTFH.  You are The Wind Beneath My Wings.

I get frustrated.  At the financial interests that pit private practice general pathology against subspecialty academicians.  It seems to happen a lot more these days than it did in the past.  Some cities get it.  They work in concert. Unfortunately, it is rare.

I have written here before about my brother.  He has an intractable case of Crohn's disease, one that has plagued him his whole life.  He has lost most of his small intestines and all of his colon.  He has been in a coma in the PICU.  He has received many infusion therapies.  He holds a Ph.D. in food science from Cornell, and a degree from the Culinary Institute of America.  He is crazy smart, a leading authority in his field.  He has overcome many health obstacles to get there.

He called me the other day.  "Hey Giz!  Guess what?  I got a family doc.  Not just any family doc, but the golden ticket one.  He works at Harvard, he is a liver specialist, but he loves family medicine so much that he devotes half of his practice to it.  He is incredibly hard to get into, but I got a referral and I got lucky.  I can't wait to get plugged in."

My brother has had a lot of issues with the fragmentation of medicine, as a patient.  He used to thrill in the bypass of the generalist - his insurance allowed him to go straight to the specialist.  And he has had a lot of specialists; derm, infectious disease, gastroenterologists, surgeons.  But now, in his mid to late thirties, he has come to the realization that he needs someone to tie it all together.  He is tired of that being him, the patient - he holds a lot of knowledge in his head but is not a trained physician.  "Giz, they don't talk.  I bounce from one to the other and get great individual therapy in their area of expertise, but communication is poor.  So I end up navigating the system, poorly as a non-clinican, and it is tough.  I'm tired.  I realize what I need is a good family doctor.  I am thrilled to finally have one."

I remember a letter recently on MiM, one from a med student looking for advice.  She clearly said, "family medicine is out - they get no respect."  I think this is a big fail in our current society. They don't get enough respect, but they should.  They should be seen as the glue that holds it together.  The ones that sweat and toil and advocate for their patients.  The ones that tie it all up in a neat knot, so that their dependents, their clients, their patients, can sit back and relax in the knowledge that they are getting good care and someone out there is advocating for them.

I empathize with the family docs because like them, as a general practice pathologist, I do everything.  I inspect labs.  I am the head of microbiology.  I look at GI biopsies every day, alongside breast biopsies.  I get called to the OR to triage unknown cases that end up being rare sarcomas or common cancers, but I don't know what until I get there.  The knowledge base I have built up over the last 7 years in private practice of the entire human being, of all of its tissues, is immense.  And I like to think that by studying everything, by getting to see all aspects of the patient, that I have become a great diagnostician.  Not a specialist by any means, but still.  I have heard the term, "Good at everything, great at nothing."  That sounds derogatory, although I can relate.  But I'll take it a step further.  I'm pretty good at everything.  And I am finally coming to the realization that my knowledge base, although not entirely specific except in my area of expertise, is good enough for what I do on a daily basis.

Global vision: knowing your whole patient, being a pathologist or a family doc, trumps tunnel vision in many ways.  But by saying that it feels that I am slamming subspecialists.  I am not.  We can work in concert, but we are all equally valuable to the patient.  And that's all that really matters here - the patient, I mean.  My brother, and the millions of others out there like him navigating a fragmented health care system.  Our patients deserve our respect.  Family medicine, our glue, deserves our respect.  If I am allowed one wish in my lifetime, I think it would be that family comes back around, and gains back the respect it deserves.  Like me.  A general practice pathologist.  We are all, patients and doctors, in the trenches together working for each other.  That is how it should be.

MiM Mail: Medical school & baby #2?

Hello MothersinMedicine,

I just started following your blog and it has been so helpful and sometimes funny to read. I am very happy that I found you!

 I am currently a second year medical student with an almost 2 year old little boy. He was born right before I started medical school. So I only know medicine as a mother. My husband and I recently started talking about baby number two and I am getting really anxious. I would love for my little boy to have a sibling but the thought of having a newborn again scares me to death. My son was 12 weeks old when I started my first year and it was hell. He was far from sleeping through the night, I was incredibly sleep-deprived, and could only study during his naps or after he went to bed at night. With a lot of caffeine. Not to mention that he was pretty difficult as an infant, was very needy and required a lot of attention.

There is also the question of when is a good time. From what I gathered, it seems like 4th year would be a good time but I am worried about how to go through residency interview season either pregnant or postpartum. Have any MiM found that to be a problem?

I am planning to go into pediatrics and wonder if having children in general would be an advantage or a disadvantage in that specialty. Do interviewers care either way? Can I talk about my experience as a mom and how it lead me to pediatrics? Since I am busy raising my little one I have not had a whole lot of time to look into extra-curricular activities such as research and volunteer experiences. I feel like that will hurt me as a candidate. And another baby would certainly not help.

 I have to mention that my husband is active duty military and is not always home so most of the child care fall on me, although that is likely to change next year as I start clinical rotations.

 Anyway, that's my MiM experience. I love being a mother, a wife and a medical student and would not want to have it any other way. I'm trying the "having it all" thing and so far it's working great. I'm always happy to read other MiM stories, I feel less crazy trying to all make it work.

Thank you!

Saturday, May 11, 2013

The Last Bu-bu

WE DID IT!!!  When I started breast feeding I was determined and optimistic!  But, as I persisted I got discouraged more times than I could remember.  There were latching problems, cracked nipples, thrush and the pumping!  PUMPING SUCKS!!!!  I celebrated when we hit the one year mark and I stopped pumping.  My plan was to allow my baby girl to self wean.  Well, she wasn't interested.  I stopped pumping but kept making LOTS of milk, so we persisted with morning and nighttime feeds.  When my baby girl was a year and a half I left the lab and went back to surgical residency hours.  My initial stint on transplant kept me at work around the clock and I felt for sure that my milk would dry up.  Miraculously it didn't and "bu-bu" time became a special time with me and my baby girl in the midst of all the chaos.  Well, the time has finally come.  Baby girl is losing interest, I've basically stopped making milk and my baby girl is a smart, amazing, beautiful big toddler now.  She hasn't had bu-bu in a week.  I put her to sleep by telling her princess stories or stories about my "doc-tur house" while she lays her head on my chest.  I'm a bit sad our "bu-bu" time is over but amazing grateful for the two and a half years we had of this amazing connection.  I'm incredibly proud of our accomplishment that survived even the insanity of residency and as always I am crazy in love with my beautiful child.  I can't wait for all the new memories we will make together.

Now off to pick some strawberries!  Happy Saturday!

Saturday, May 4, 2013

On Being Imperfect - Topic Week at MiM

Welcome to our topic week celebrating imperfection. All the posts this week contributed by readers and regular contributors will be about this in some way - our thoughts, our stories, our confessions, our revelations. Thanks to all who have shared. All hail the sometimes messy but (hopefully) meaningful life of being a MiM.

Posts will be spread out across the week and will appear below. Thanks for reading.

Cutter's extra random top 10 list of imperfection!

1. I've allowed my daughter to watch 4 hours of consecutive Dora while I half sleep on the couch post call (unfortunately this one has happened more than once!)

2. The tired mama: In the middle of telling my daughter a princess story to help her go to sleep I heard myself say "prepped and draped in the standard sterile fashion" to which my baby girl responded with "WAKE UP!  More PRINCESS MOMMIE!!!!"

3. A happy meal 

4. Letting baby girl sit in a dirty diaper for about 30 minutes to long because I was just TOO worn out to change it

5. I understand mom jeans now - how else do you rein in all that belly!

6. I can't do it all, which means I struggle to read enough and I'm sometimes late to work - especially when I go to kiss my baby on the way out the door and discover that she has collected a mountain of poop right by her head!

7. Occasionally I wear swim suit bottoms to work as underwear.

8. I'm really bad at dictating in a timely fashion once I get behind.

9. I owe lots of library fines.

10.  My hair looks terrible nearly all the time!

The Bear of Shame, or the Story of the Mother Who Didn't Have Wipes

Today was a beautiful day. This winter has had a long and unexpected and not entirely welcome coda this year which has only sweetened the anticipation of spring. Today the sun was out, the sky was cloudless, the temperature was just warm enough for short sleeves but not warm enough for sweat. I got out of work early--I am in the Emergency Department this month, so am working half the number of hours I usually work, though at odd hours--and raced to pick up my daughter early from day care. The thirty minute drive from work to day care has a sweet, crazed quality to it--never am I so eager to reach a destination, never am I so irrationally angry at anything or anyone who causes the moment of arrival to be delayed. After picking E up, I decided to take her to a nearby park in the adjacent but much ritzier neighborhood a few minutes from our house. Instead of the space-age shock-absorbing pseudo-gravel that carpets most playgrounds these days, this playground is carpeted in sand, ye olde original shock absorber. It was E's first encounter with sand and while initially tentative, she was soon letting out excited squeals and hurling sand into the air and by extension into and onto every part of her, including the area between her nose and her mouth in which snot has taken up semi-permanent residence since she started day care. There I was in my barely-nice-enough-for-work-but-certainly-not-casual-enough-for-the-sandbox attire, with a toddler whose face was covered in snot-stuck sand. All I had with me were my keys, my smart phone, and E's hoodie. I did not have wipes.

The playground was full--mothers, father, babysitters, grandparents, nannies. I walked over to someone who seemed to be a nanny--surely they come prepared!--and asked if she had a wipe. "I'm still learning," I said, by way of explanation. "Oh, that's why we're here to help each other," she said, and I felt good about humanity. She opened the child's blue elephant backpack which I could see was meticulously arranged. "Her mom sure knows how to pack a bag," she said, pulling out a travel-size package of all-natural hypoallergenic wipes.

Well, there it was. Her mom sure knows how to pack a bag. I imagined the woman out there in the world of work somewhere, calm in her knowledge that should her child be caked in a mixture of sand and snot while at the playground, there would be a wipe at the ready. As I walked back to my delighted daughter and wiped her face, I thought to myself: Am I ever going to get my s&*t together?

Sadly, it's a familiar refrain. My thank you notes are still not done from E's birthday and the holidays in December. I sent off the ones that were truly socially dire (grandparents, great aunts, co-workers) and now I'm wondering if it's even polite to send the others. Is there a statute of limitations on gratitude? Speaking of the holidays, I just couldn't make a holiday card happen this year, so you won't find my daughter's adorable face on a refrigerator near you. The baby book I lovingly bought when I was pregnant remains half-finished, with only the pregnancy section filled out. When it came time for my daughter to go to day care, we were not on any of the right waiting lists. A year later, we still aren't. When it comes to potlucks, I either bring store-bought hummus and a loaf of bread (from Whole Foods, though, so maybe a couple of extra points there) or I just decline the invitation upfront because I foresee that the guilt of not having made a homemade casserole will just be too much for me. I have even shown up to a potluck with my daughter having brought nothing and proceeded to feed her everyone else's food because she was hungry and I hadn't even brought snacks for her from home. On Valentine's Day, my 14-month-old returned home with a Valentine's goodie bag from one of her classmates and I just had to throw up my hands. Am I supposed to be cutting Valentine's hearts out of construction paper after my child goes to bed to give to her barely ambulatory classmates? And if so, who is going to finish my notes from clinic? Most nights, I go to bed feeling like a there's a bear hibernating next to me -- the bear of all the things I'm supposed to be doing, am late doing, don't know yet that I'm supposed to be doing -- and I just try not to wake it up. Just give me one more day, bear of shame....

But here is what I will not do: I will not waste any of the time I have with my daughter on the bear of shame. Our time together is not an expansive as I would like it to be, so I am going to use it to delight in her and in the world with her. I will try to get better at the thank you notes and the day care waiting lists but I will do that after she has gone to bed and if I'm too tired, I will go to sleep instead. I will probably never show up at a pot luck on time with home-baked goods. Many things will remain undone or not perfectly done. But E and I, we will do lots of fun and interesting things together. I may not have my s*%t together, but at least I know what's important to me. I'm probably never going to get rid of the bear of shame, but it's not going to eat me either.

So the Story of the Mother Who Didn't Have Wipes is actually the Story of the Fun Afternoon at the Playground. Instead of remembering that I didn't have any wipes and some other mother had remembered to pack them, I will remember my daughter's gleeful shriek as she wiggled her toes free of the sand piled on them. I will remember her little finger pointing up at the sunlight seeping in between the leaves of an enormous old-growth tree. I will remember her look of surprise as I blew the seeds off a dandelion and her subsequent earnest attempt to locate and un-seed every dandelion in the neighborhood. And hey, maybe I'll put a packet of wipes in my glove compartment tomorrow, because  I may not be perfect but at least I can learn.

Friday, May 3, 2013

Snippets Of Imperfection....

It's Being Imperfect Week... I don't know where to start.

1. I fed my cats a 5$ can of fancy Italian tuna packed in olive oil. 
I had clinic all morning, admin all afternoon, battled traffic, picked up the kids from Nana's and then brought them home, practically tripping over our two needy, oversized rescue cats, they wending in and out of all of our legs begging for food. We were out of wet cat food. Damn, I thought, got to put that on the list. Meantime I'll give them tuna. But all we had was this overexpensive shmancy tuna from Wholefoods. Why on earth did I spend 5$ on a can of stupid tuna? Because Giada said so, that's why.While I was on maternity leave,  I spent many hours breastfeeding on the couch, flipping through foodie shows. You gotta love Giada. She can smile and talk at the same time; her eyes practically pop out of her head as she says things like, "Next time your best girlfriends pop over for an unexpected lunch, you can wow them with this yummy White Bean Tuna Salad, made with ingredients from your pantry! I like to use high quality tuna in olive oil." Well, after 6 p.m. on a weeknight when the kids need to get in the tubby and the cats are frantically hungry and practically eating my legs, is not the time to worry about wasting money. Open went the can and plop into the cat bowls. They loved it. I think they were wowed.

2. I showed up to work on a day I had asked for vacation. 
I've actually done this more than once. I can't keep my schedule straight sometimes. We have to ask for our vacation days months and months ahead of time, yet hubby's schedule can change on short notice, so sometimes planned vacations get moved around... I have not yet developed any good system for recording all of this. I have a paper calendar that gets a bit over-marked-up, and I use Google calendars, which is synced to my iPhone calendar. Yet things still fall through the cracks. Amazingly, I have not yet NOT shown up for work on a day I was supposed to work. I don't think... actually I may have.

3. I forgot to pay the mortgage. For two months. 
In my own defense, I had had to open a new checking account, as a check I had given to one of Babyboy's behavior therapists had been stolen out of her car. THAT was a pain in the ass. But I did it, and I had even re-set-up the mortgage automatic payments... not realizing that it takes two months for that to kick in, and I needed to manually pay the mortgage in the interim. You would think that after two months I would notice that that amount of money was NOT being deducted from my checking account, but nay, I did not. Things were crazy as usual and I have all the bills on automatic billpay, so I never even looked at my balance. Until the mortgage company started calling. THEN I had a heart attack, explained everything five times, and paid immediately. Then, for weeks afterwards, we got calls from them asking us if we'd like "to talk to someone from customer assistance about our difficulties meeting payments, just to review our options"... which is nice, that they offered, but it was also embarrassing.

4. I had to steal feminine products from the office.
I can't keep my schedule straight, so obviously I can't keep my cycle straight. I've been surprised by my own body more than once. If whoever stocks up the feminine hygiene products at work is wondering why we're always low on these in our area of the office, I am to blame.

5. I had cookie dough for dinner on Saturday.
Hubby was at work, and me and the kids were a bit late-ish getting home from Nana's. I got them home and out of the car, but Babyboy balked in the yard. Sometimes Babyboy will just NOT go into the house. He'll bolt into the yard and play "run away from mom". And to get into our house from the driveway, we have a somewhat rickety set of wooden stairs leading up a story to the back door, so it's pretty impossible to wrangle Babyboy as well as carry Babygirl and everything else into the house solo. I knew I had to get them through dinner and tubbies on my own, and the best way to get him up the stairs is for him to walk.  So I bribed him. "We'll bake cookies!" I promised, and up he went, like a little monkey, repeating "Bake COOKies? Bake COOKies?" He LOVES to bake cookies; he even can pull all of the ingredients from the pantry and lug them to the kitchen counter. It's adorable. Also I discovered that cookie bars are fast: SO much easier to make than individual cookies, and people like them better anyways. Anyways, I did get dinner into them both, and the cats fed (not 5$ Italian tuna), But with all the activity, I never got dinner of anykind for myself- so right before the cookie bars went in the oven, while the kids were distracted, I got out a spoon and enjoyed a little treat as my dinner.

6. I went 72 hours without a shower last weekend.
Not the first time I've gone such a stretch, but probably the first since maternity leaves.... It was just one of those weekends. The whole childcare team is down with variations of the same lower respiratory thing. Our Babysitter left early Saturday with a bronchitic cough and the chills, and I had had only enough time to run one big errand (grocery shopping) before she crawled out the door. Hubby was away/ working all weekend, and Nana is also sick, though she did help us out for some short stretches, I didn't want to overwork her. Our neighbor also helped out here and there, but I don't want her to start avoiding me! There is no feasible way to bathe with two kids under thre years old on the loose. So Saturday, then most of Sunday, went by without me washing. AND I was out and about, to the neighbors'; to a friend's barbecue; I even hosted a family dinner on Sunday. Good thing our neighbors, friends and family don't seem to have any issues with my body odor... or at least, as far as I am aware.

7. I throw temper tantrums. 
Babyboy can really throw a tantrum. This week he had multiple tantrums for two days in a row. He was getting over a cold, and we think he just didn't feel good... That or he was overtired. Who knows. Sometimes, he gets fixated on something unreasonable/ irrational, like, he has to be up at the altar at church. Or he doesn't want to leave play group. Or he doesn't want to change out of pajamas. Or get in the tubby. And he kicks/ flails/ screams/ cries for up to, and sometimes over, an hour. It's really grating on me when he does this. He is utterly inconsolable. Last tantrum, after 45 minutes, I went to the pantry and pulled out every treat I could find, offering ANYTHING to him if he would JUST STOP SCREAMING. I mean, I was yelling and begging at the same time. His reply? A snuffly, barky: "No. want. treat. Want. go. back. PLAYGROUP." At that point, the babysitter had come and his behavioral therapist was there, so I just had a silent tantrum of my own. "I have to step away," I explained, and I left them with him. Just walked away. Did something else for awhile. He did eventually calm down, and they all said they understood, but I felt bad.

8. I really throw temper tantrums.
I once was so angry at Hubby, I threw raw cookie dough at him. (I guess we make alot of cookies in our house...) It fell short, missed him, and plopped all over the floor. Our fat cat scrambled over to sniff and lick at it. Anyways, it was so ridiculous, we ended up laughing about it. I don't even remember what the fight was about.
9. I have gotten lost in my own town.
Or rather, I have been so distracted that I drove to the wrong place, or forgot where I was going, or I missed the turn. I have called our close friend's kids by the wrong names. I put the wrong last name on a Christmas card to a neighbor. I have written checks in the wrong amount; I have written checks to the wrong names. I rip up alot of checks. I forget birthdays, even when I mark them on the calendar. I forgot administrative assistant's day last week, AGAIN. I clip coupons for the store and forget to bring them; I bring a list to the store and forget something THAT IS WRIITEN ON IT. Not all of these things in the same day, but at least a few in the same month. I see these errors as red flags that I am too busy/ overtired/ stressed, and something needs to go.

10. I am too busy.
Isn't that at the heart of so much of our imperfection: we are all too busy. We have dueling responsibilities; to our patients, colleagues and staff, to our families and communities. Modern life is complex, and creating balance is managing a large, fragile, unwieldy thing. But what it boils down to is simple: Slow down, take some time to appreciate the most important things in life. SIMPLIFY.

no such thing as perfect

Guilt was one of the first feelings I experienced upon learning I was pregnant with my daughter, now 4 years old.

I had been on a pub crawl the night before, gotten home around 2 am and woke up a few hours later miserably sick. This might seem to be expected after a night out on the town, but had gone to bed sober and hadn't drank that much. I had taken a pregnancy test a few weeks earlier, prompted more by nausea and fatigue than a missed period as stress-induced amenorrhea was not new to me. It was negative.

That morning, not able to shake the fact there was something very wrong, I took a (second) pregnancy test. Positive. I took another. Positive. I took a another. (still) Positive.

Pregnant, drinking, not taking folic acid, and ignoring what my body had been telling me for weeks- which was Have Some More Water. Now Pee. Nap! Eat Some More Bread. I thought about my booze-soaked "intern week", which must have occurred right after I got pregnant.

I was already failing motherhood. It became a recurrent sentiment in my daughter's first year of life. Breastfeeding and pumping were more difficult than I had predicted. We used store bought formula and baby food. She develop a taste for Mac N Cheese. As a resident, I didn't know our pediatrician.

A few years passed. I did some growing.

I have a good friend, an ivy-league educated attorney, who wants nothing more than to home school her children. I have another friend who posts on her FB page links to articles about the treacherous and unregulated world of daycare (the most recent was about a home daycare that burned down) or an admonition to her baby group that, really, if breast feeding was that hard our species would have died out eons ago. These are both woman I like and respective very much.

In my first year of motherhood, these things would have bothered me. Why didn't I want to home school? (And believe me, I don't.) Am I putting my children at risk in daycare? Is my daughter going to be fat, sick, and anti-social because I didn't BF for 12 months? Was she already missing out on activities that would prove pivotal to her future success because I wasn't around to shuttle her from one to the other?

of course not

It took some time to become comfortable in motherhood, which itself has been the most intense and important undertaking in my life. That being said, I've come to realize that, for me, the Perfect Mom is not the Total Mom. I don't have a cohesive philosophy on motherhood save that the vast majority of us seem to be trying as best we can, and how we implement our universally-held good intentions is both personal and family-specific. In regards to home schooling, prolonged BF-ing, nanny-care, organicthisthatandtheother, epidurals, music appreciation class - they are all part of a decision making process that is individual to your family and lacking in any specific moral imperative.

For me and my family, its best that I work. Aside from the obvious financial implications, work is good for me. I enjoy what I do and I choose to believe my children benefit from having a mother who feels this way about her vocation, even if it means daycare and formula and dinners on-the-fly.

I am not perfect. I get cranky, irritable, and short with people, some of them my offspring, who deserve my patience. I don't think this makes me a bad mom, I think it makes me a human being. I gave up perfect a long time ago.

Although, all things being equal, I wish I hadn't drank during the first few weeks of my pregnancy...

Thursday, May 2, 2013

Booty, booty, booty, booty

My talking toddler is an amazing little creature. At first he would mostly babble and jargon, now he says sentences. His newest feat is to repeat words he hears in music we are playing or on the radio. My husband is a hip-hop aficionado but songs with curse words have now been relegated to the after-bedtime hours for fear of having our toddler repeat them to his teachers at school or on the playground. He doesn’t really repeat things he hears on NPR, but I am hoping that one day he will start reciting things he learns on All Things Considered or better yet from the TED Technology hour.

I must admit that I taught him a “bad” word. Completely unknowingly. It’s not even a real curse word but it’s still not something I want him to repeat with hand movements. To keep him distracted during diaper changes and during his twice daily rub downs with petroleum jelly (he has had some eczematous flares that are now under control), I would recite body parts to him and tickle him. When I got to his butt he would giggle as I said “booty, booty, booty”. 

One day as I was changing he ran up to me and said “booty, booty, booty” as he grabbed my butt; full on butt grab, the little bugger just dug in. I laughed, handed him a truck and kept it moving. It became concerning when he would bee-line toward me any time I was changing or heading to the bathroom. He would recite “booty, booty, booty” as he proceeded to grab my butt, he even tried to reach into the toilet once. He has now become a Booty Monster! My husband and I have been working for the last 2 weeks to get him to understand not to touch butts or other private parts. He’s almost 2 so this process goes mostly like this:

- see smiling toddler approaching with hands raised and fingers splayed saying “booty, booty, booty”
- Mommy says “no Zo, this is mommy’s booty, you cannot touch”
- Zo looks questionably at Mommy (I know he’s thinking but a few weeks ago you were laughing)
- Mommy hands Zo a toy
- Zo takes toy and runs or more likely, Zo takes toy, throws it on the ground and begins to cry
- repeat daily for weeks and weeks and weeks and weeks

Now, Mommy second guesses every gesture and phrase that is now cute but could potentially turn Zo into a raging maniac. Who knew? Not this Imperfect Doctor-Mama. Fingers crossed he isn’t doing this at school but I just can’t bring myself to ask his teachers.

Guest post: When imperfect feels perfect

I’m writing this with my laptop perched on a giant stack of review notes and printed lecture slides and I am purposefully ignoring the multiple powerpoint slideshows and files open on my desktop begging/demanding to be memorized. The worst part? My baby is at daycare, where she’ll be for another half hour to complete her 10 hour day. This is just so hard and sucky sometimes.

I’m a med student with a baby. I get asked all the time how I “do” it. Some weeks, it’s no big deal, it’s not that bad, and I feel the balance works well for our little family. But when she is brings me her favorite book to read, pulls the charger out of the computer, and screams until I read to her, I think to myself that I don’t know if I can “do” this, or even if I want to.

I have friends who have babies, too. One is a full time SAHM. Her instagram pictures of nature walks, arts and crafts, and “Sunday/Monday/EVERYDAY Funday” kill me a little bit inside. Another friend works from home and her pictures of “lunch with the little prince!” make me sigh/roll my eyes/shake my head (depending on the day, the most recent Histology quiz, or whether I got to see my baby before heading out in the morning).

I picked priorities. She was drinking formula at 3 months (end of summer vacation) but I made all my own baby food. Her grandma takes her to music class once a week since I can’t, but I put her to sleep every night. We read books and play all day Saturday, but Sunday mornings I go out to study.

My husband is awesome and supportive and doesn’t understand how I can love the field of medicine, love school (nerd, I know) and still feel so conflicted. I guess that’s the imperfect side of living your dream- other dreams sometimes get put to the side for a bit.

But as imperfect as the balancing act seems, when my baby is teething and only wants her mommy- and, since it is 3am, I am home (and awake), or when I get that HUGE smile and kiss when I come home, it feels so perfect. I’m sure some researcher somewhere has proven that listing bones, ligaments, and muscle attachments as a bedtime story, and speaking in mnemonics for disease presentations helps kids go really far in life. And keeps them happy. Here’s to hoping.


Wednesday, May 1, 2013

Less than perfect

I admit I’m not a perfect mother.

I wish at the end of the day, I can see all the bathwater that has sloshed out of the tub and likely making its way down cracks in tile and through the subflooring, and not angrily bark at the kids (who are at least in the tub and getting clean). After I bark and they are settled into their beds as I read their bedtime stories, I imagine how I could have handled it differently: with less anger, more love, and more humor.

I wish I could make them do things that they don’t want to do without the aid of bribery or sheer parental authority force. Like being creative and using Jedi mind tricks. Like being a positive shaping force instead of a strong-arming wet blanket. I manage to do this well sometimes, and others…well, I default to those methods which take the least time and energy.

I wish I could always be 100% attuned to them and their needs when we’re together, instead of being preoccupied with what I’m doing on the computer or the laundry or the person on the other end of the phone line. I realize this sometimes only after they raise their voice to tell me something again. Or act out to get my attention.  This always makes me feel guilty, vowing to try harder.

I wish I could put aside all of my stresses – and there are many big ones I deal with every day –when it comes to taking care of them, instead of letting those stresses spill over messily into my precious family time.

I have friends whom I think are better mothers. I imagine: what would she do in this situation? Or how would she handle this? Probably with more patience, I think. Less frustration, most likely. More accepting, I bet. This helps me be better in the moment, or sometimes the moment has unfortunately passed, but I’ll try to remember for next time.

I’m not a perfect mother. I’m a work in progress. But, I hope my children know how much I love them, and how much I think of my own imperfections, so that one day, we all could not be prouder of the mother I have become.

Posted originally on

My Holey Life

I desperately need to go shopping.

I am a physician, a professional, a role model, etc. Yet this is what the sole of my shoe looks like:

This is my underwear:

The cuff of my pants:

My socks:

(In my defense, those socks are only about a year old. I think our dryer eats clothing.)

And just in case you had any doubts in your mind that I am about as far from perfect as you can get, here's a photo of my child on a leash:

No, you can't pet her. But thanks for asking.