Thursday, June 27, 2013

MiM Mail: Finding a career in medicine in your 40s

Hello Mothers in Medicine!

I'm a 41 year old mom of two kids, ages 13 and 10.  About 3 years ago I thought, ok... it's time to start thinking beyond stay-at-home mom jobs that are part-time and intermittent.  It's time to think of what career I want to choose, now that my kids are in school during the day.  I have a bachelor's degree in Social Work, with a minor (actually almost a major) in music.  I love working with people.  But, after working in the social work field for 6 years prior to having kids, I decided I wanted something different. I also taught music for several years while my kids were at home, but found I wasn't being challenged enough. Social work was too open-ended for me.  I wanted to diagnose a problem, then make a plan to work on fixing it. Around this time is when my mother became very ill at the age of 68.  A normally healthy active person, she exhibited many odd symptoms that stumped many doctors.  Finally an infectious disease doctor diagnosed her with Cryptococcus Gattii, fungal meningitis.  I helped my parent's through her horrible disease, and realized after a year of her being in and out of the hospital and rehab facililties for physical and occupational therapy, that I loved medicine. It was the hardest year of my life, watching my mom suffer.  And, it also changed me.

In a casual conversation with my mother's doctor, he said, "Oh, I think you'd be a great doctor!" Something clicked in my brain at that point, and I began to obsess over the possibility of becoming a doctor. I couldn't get it out of my mind. I spent the following weeks researching programs, and figuring out what I'd need to do to get into med school.  Of couse, I quickly became overwhelmed with all the classes I'd have to take. But, I've started taking one prereq class at a time.

Here's where I'm passions really are mixed.  I love medicine, and helping people heal.  I also strongly believe that we need to treat the whole person, not just the disease.  I believe that helping a patient in the healing process involves not just the medicine, but their nutrition, their mental and emotional health and well-being, and finding the source of the disease and treating that. Asking the question: "Why did the patient become ill/injured in the first place?" is a really important question.  Because of this approach, I'm very interested in Naturopathic Medicine, integrated with Allopathic Medicine.  I'd love to see the two working together.  Both have important things to offer, and both are critical in the healing of the whole patient.  My mom would have died without the administration of Amphotericin B. But, I can definitely say that naturopathic medicine could help clean up the aftermath of the disease, if it were included in her insurance. I would love to become a Naturopathic Physician.  But, again, I am 41 and have kids.  Doing this would mean 4 years of medical school, plus a residency (which in natural medicine is usually about 2 years). Another option would be to become an MD, instead of an ND, and focus on integrative medicine. This is looking at 4 years of medical school, plus about 4 years of residency. My OTHER option is to become a Physician's Assistant. It basically requires the same prereq's as the other degree's, ND and MD, but it's only 2 years of intense schooling rather than 4-8.  I would need 2000 hours of health care experience in order to apply to a program, which I don't have yet. It would take me 8-10 years to become a doctor (prereq's + med school + residency), and about 4 years to become a PA ( prereq's + healthcare experience + school).

Another problem area for me is that I am not able to uproot my family for schooling.  I live an hour away from an excellent medical school (OHSU), and also an hour away from a really good naturopathy school (NCNM). These two schools would be my only option to become an ND, MD, or PA. Kind of putting all my eggs in one of 2 baskets!  I'm leaning toward becoming a PA, just because it's less time, and I'm older.  Plus, I could work in an integrative clinic and do the natural health stuff that I'm interested in.

Here's some questions I have for you:

What's it like to be in med school when you have kids? Can you have any sort of life?

What are your thoughts on ND vs. MD vs. PA, considering my age and phase of life?

We are a single income family, and make about $70,000/ year. We've learned to live simply, but I'm worried about the amount of bills I will rack up in medical school.  Is this a valid fear? How long did it take you to pay off yours? I fear that I'll be spending my entire career paying off my med school bills.

If you had it to do over again, what would you have changed?

So many people say to follow my dreams, and go straight for becoming a doctor.  But, they don't realize how much sacrifice that would be for my family. If I didn't have a family I would definitely become a doctor.  But, I don't want to lose what I have with them. This is why I am seriously considering becoming a PA. Am I cheating myself? Or just being realistic?

Thanks for reading my really long message.  I'd love any input any of you might have.  I know you're very busy with career and family.  So, I will be patient and wait for your response. Thanks for your help in this huge decision I'm making.


Monday, June 24, 2013

Pump hero

I needed to meet with a team to grade their students and had set up a time to meet them in their team room. This is one of the best team rooms we have in the hospital. It's spacious, with a wall of computer stations on either side, and windows lining the opposite wall from the door, filling the room with natural light. When I'm bringing the third-year students around to their team rooms after orientation, I always deliver this team's students last since it's kind of like closing the curtain between first class and coach.

I walked into the room and saw a medicine intern with her back to me, working at her computer. At the other wall, the senior resident was reading some papers before him. They greeted me as I sat down with my folders and took out my forms for grading.

"I hope you don't mind, but I'll be pumping while we do this." In the sudden quiet, I heard the telltale rhythmic sounds that I knew so well. She was pumping. Right there. In the team room. I didn't notice earlier, but she apparently had a hands-free set-up going, and was typing away, doing her notes. I glanced back at the senior resident, nonplussed. This was routine business.

I was filled Admiration. So impressed.

"I think it is so awesome that you pump in the team room!" (Could I have?)

"I've lost all modesty after 9 months," she said with a smile.

We graded. She finished pumping, cleaned up, stored the milk, and I could not stop smiling.

Saturday, June 22, 2013

A Tribute

My program has survived a ridiculous and trying week of great loss.  Sunday, our former Chairman, a giant in the field of surgery, died.  His family was by his side.  He has lived a life full of amazing accomplishments.  He has touched the lives of many patients, taught many residents who have gone on to accomplish great things of their own.  His death was shocking for many of us, others already knew he wasn't well the past few weeks.  He is a presence in our department that will be sorely missed.  Dr. S, your legacy will live on forever.

Early Monday morning we heard that one of our young budding surgical oncologist died.  He died overseas as a visiting scholar - a huge honor that he was so excited about.  He was only 42 years old - the always beaming father of three beautiful little girls.  His death was completely random and sudden.  This was a crushing blow.  My second year I spent nearly my entire oncology rotation doing breast cases with this attending.  Listening to all three of Shaquille O'Neal's albums (yes I said THREE!!) and he knew all the words.  Again, let me repeat -  He knew ALL the words.  We bantered over our Eagles/Cowboys rivalry.  Last year when the Eagles beat the Cowboys I wallpapered his office with "Fly, Eagles, Fly" posters.  One year I operated with him after the Cowboys beat the Eagles and he wore his Cowboys hat and lanyard and brought cowboys paraphernalia into the OR just to taunt me.  He swore by the wall of 4-0's in his mastectomy closure, a move I've probably complained about but will likely follow someday in by own breast onc practice, which I plan to specialize in.  I talked to him briefly about my career plans, we were waiting to sit down and plan this year.  I haven't operated with him in the last couple of years but I have an Eagles hat waiting and specially made just for this purpose.  700 patients.  There has been immense outpouring of love and disbelief from his patients.  So many lives saved.  I pray that his girls will always know that their father's life was lived with purpose and meaning.  People can live 100 years and not touch a fraction of the women and men who have been cured, supported and cared for him.  I hope they will always remember the times they did have with their father.  I want them to know that he bragged about them constantly, that he lit up every moment he spoke about them, that he inspired us to see how the love of parenting and doctoring could go hand in hand.  He put them first.  You were his heart - his girls and his beautiful wife.  He was so proud of all of you.  Dr. A, our hearts are breaking, you will be greatly missed.  

Wednesday, June 19, 2013

Summer Vacation

Last summer I was picking vacation
And I vowed there would be no staycation
I would travel far and wide
To have friends and family by my side
I wasn't going to wallow at home in frustration

The pinnacle choice was tough
What could I do for my kids that would be enough?
I was dissecting an arterial branch
When I decided, "Maybe a dude ranch!"
That would surely get us off of our duffs.

I imagined us astride marvelous steeds
And Mom and Dad reluctantly agreed
So I researched and planned
Thinking of gold being panned
And lots of farm animals to feed.

Last week my plan came to fruition
We embarked on our tour of Colorado nation
With cowboy boots and hats in tow
We were ready to hit the rafts and row
Our way into Yampa River's gestation

Day 1: After only thirty minutes on my steed
He decided to fall to his knees
He rolled over in supplication
I had to scramble to avoid suffocation
Luckily the only casualty was a bruise on my knee.

As the bruise bloomed into its own planet
I vowed, "No more horse for me damn it!"
I biked, kayaked and hiked
While the rest of the family liked
Their horses so much I couldn't stand it.

They walked, they trotted and they loped
They learned how to corral cattle and rope
I smiled from the water and ground
Control I had found
I made peace with my lack of ability to otherwise cope.

Now I'm back in my office at the scope
With guarded but optimistic hope
It's time to pick vacation again
It cannot be a sin
To change course to avoid looking like a dope.

Alaska cruise anyone??  Disney??!!

Alas, Cecelia wants to go back to the dude ranch, "Way better than Disney, mom."  I have to admit I loved Colorado in the summertime - wildflowers and Aspens with fluttering leaves that looked like a million chartreuse bug wings in the wind.  Luckily there is plenty to do that does not involve large animals with minds of their own.  Good vacations inspire cheesy poetry.  And they generate lovely pics.

Sunday, June 16, 2013

Senior Resident, who me?!?

In less than 2 weeks I will be a Senior Resident. I cannot believe how far I have come. At a social event to welcome the Incoming Interns this week, one of the newbies turned to me and said “I have heard all about you, I can’t wait for you to teach me”.

Teach you?!? Who me?!? (I of course didn’t say this but the chuckle I gave probably betrayed me)

The wimp in me wants to jump back and put the brakes on the whole transitioning to a Senior Resident thing, but if I breathe slowly and reflect, I know I have been trained to do just this: be a freaking awesome Senior Resident.

Here is a list that I started working on today (while on overnight call) that lets me know I can do just this:
  • ran a real code blue situation my 1st week of Intern Year and the patient survived and did pretty darn well
  • learned how to manage and crosscover patients with a myriad of conditions from bladder exstrophy, to double outlet right ventricle, to constipation - in both an inpatient and outpatient setting, to neonates of mothers with positive drug screens for every illicit and abused drug you can imagine, to medical child abuse, to motor vehicle accident, to status asthmaticus, to poor weight gain/ failure to thrive, the list goes on and on
  • learned how to succinctly and efficiently sign out my patients and receive sign out from another resident
  • learned how to admit and discharge patients efficiently and effectively
  • learned how to work with all sorts of different people with different roles and aptitudes
  • learned how to “balance” work and life (meaning, I punt tasks such as planning my child’s birthday party when I can, I get help when I can meaning hiring a cleaning lady, I drink wine when I can, I laugh when I can, I sleep when I can, I travel when I can, I do my eyebrows/shave when I can, I catch up with my family and friends while commuting home when I can, this list too can go on and on)

So, regardless of how I feel in the moment, the Senior Resident in me has to take over in t minus 2 weeks. A pep talk that my father always gives comes to mind. He looks me straight in the eye and says “are you a man or a mouse?”. Obviously I’m neither, but I have been taught to return his gaze and yell “I’m a man!” So starting now “I’m a Senior Resident!”. Hoping the Transfer Center calls sometime over my call shifts this weekend so I can act like a Senior Resident while there is still a Senior Resident here to guide me.

Wish me luck!!!

Thursday, June 13, 2013

MiM Mail: Organizing other MiMs


I'm a single mom of three who will be starting a combined IM/Reseach residency in July.  For all of the MiMs, how do you/did you interact with other mothers while in training?   It would be so nice if there were an official group or club, but if it's not available, I don't know if I would be the right person to organize it.  I'm a little older and have been out of the game for a while doing research, so maybe there aren't even many women who will be starting a family and would be interested. Is anyone aware of any good models?
Many thanks!

Wednesday, June 12, 2013

How many kids?

I read an article today about having a single child household by choice. Apparently, every child you have adds 120 hours of housework yearly.

I had a second child because of the unselfish reason that I think siblings are important, and the selfish reason that I wanted to experience those early childhood years a second time. I don't want a third for the totally selfish reason that it would just be too much work for me. I long for a time when I can sleep as late as I want on weekends.

What are your reasons for having one or more than one child?

Friday, June 7, 2013

Moments When Mothering and Medicine Don't Mix

This post was inspired by one I just read from Genmedmom, on her own blog.  It is called Falling off the Work/Life Balance Beam, you can read it here.  I was oozing empathy, after all, she is going through this in real time, and it made me remember one of my worst moments.

When Cecelia was 5 and Jack was 3 (or thereabouts), I got a page on clinical pathology call.  It wasn't a good time - I was just telling the kids we had to find a new home for our almost one year old dog Mason.  Long story short he was a bullish German Shepherd that kept getting out of the gate and terrorizing the neighborhood animals.  Even though we were within city limits, there was a family down the road that had a chicken pen with 6 or 7 chickens - I walked down with the children and visited them on occasion.  They are a wonderful family - the wife has a healthy local business.  My family had been celebrating someone's birthday the night before - extended family - and one of the kids announced "Oh look!  Mason's in the back yard playing with a stuffed animal."  It wasn't a stuffed animal.  It was a chicken.  Emphasis on WAS.  That was the last straw.

After a bad first home we placed him with a medical student who was going to be alone for a year in her parent's house while they traveled abroad; she needed a good guard dog/companion.  She wanted one that was house trained.  It was a good fit - Mason did not need to be around small kids, being like a bull in a china shop - I was forever tightly wound if he was in the back yard when my kids were navigating the flagstone steps from the deck to the patio.  He was a sweet dog, but one squirrel sighting and he shot off like a rocket with no heed to anything or one in his path.

So I was telling the kids about Mason, and they started crying, and I got paged.  It wasn't just a, "Here's a critical value and I can't get in touch with the doc could you help me" from the lab page, it was a "we need an emergency plateletpheresis now, they're over a million!" page.  Ugh.  The kids were howling so loud I stepped out on the front porch to listen to the heme/onc tell me the patient history so I could contact the dialysis nurses with the right amounts/formula to get things going while I was getting there.  I called my sis-in-law who agreed to come over and watch the kids while I went in.  Then I turned to the front door to go back inside.  It was locked.

My frantic kids were trying to get to me and accidentally locked the front door.  My heart skipped a couple of beats until I realized I could flip the mail slot and see them, touch them, talk to them.  They were sniffly but ok.  I coached my daughter on how to unlock the door and when we eventually were successful I tumbled in and we all collapsed on the floor in tears.  Mason.  Needing Mommy.  Loss.  We were a big mess.  Sis-in-law walked in thankfully when we were on the downswing, drying our tears, and I announced, "I think milkshakes are in order!" I pulled out the ice cream and was happy to see smiles as I was walking out the door.

I cried all the way to work that evening.  I think I called a friend, hard to remember.  I think I was crying more for my children's loss than my loss - I don't know it was all rolled up together, emotions indistinguishable from one another, muddied and blended.  And I was crying for Mason, even though I knew he needed a better fit.

Good luck Genmedmom, it gets better when they get a little older, or at least easier.  And the moments where mothering and medicine don't mix are just that.  Moments.  Most of it is incredibly awesome.  Although us MiM's have unique challenges, I think I can speak for all of my mom friends, SAHM or mothers not in medicine, to say that all of us have these moments.

Thursday, June 6, 2013

MiM Mail: Should I uproot my family?

I've followed this blog for many years and I desperately need help. I recently had to take 1 year off from residency due to medical issues. My daughter and I are both doing well now and it's time for me to go back. Despite many challenges, this year has been a wonderful experience bonding with her. When I return to residency she will have turned 1 year old and I will be transferring to another program. The problem is I don't know where to live and I hate to uproot my family. If we stay where we are now my husband will be 15 minutes from work and my daughter will get to maintain her relationship with our part time evening nanny whom she absolutely adores (she helps me now about 3-6 hours/week). Additionally, my mother in law loves the area we live in now and would probably stay with us for maybe 6 months if we stay. The only problem is that my commute would be about 1-1.5 hours driving or via public transportation. I've been away from medicine for over a year and I want to succeed when I go back, I'm not sure if commuting is such a great idea. And I've never been away from her for more than a few hours, seeing her for a few hours each night after a long commute is going to be a huge change for both of us.

If I put myself first and move the family closer to my new program I will have a 25-30 minute commute, my husband will have a 45 mile reverse commute against traffic (50 min-1hour). But mother in law help in this scenario would be unlikely for any extended period of time. We would put my daughter in daycare sooner rather than later. There would also be no nanny help at night (my daughter loves her and she is not an easy baby!) because the nanny doesn't drive.

I only have 2 years of derm residency remaining but I have so much at stake since I will be starting a brand new program after being away for a year. I really want to put myself first and move closer to the new program so that I can give myself the best chance at success but I don't want to uproot the entire family. I feel so guilty because we have moved so many times in the past. On the other hand I don't know if commuting from where we currently live to my new program will be the best choice for my career/performance. My husband is supportive of whichever route I choose but I've been agonizing over this decision and am no closer to a solution. I keep myself up at night weighing all the options until I feel sick which I know isn't healthy. Please help me!!!

Monday, June 3, 2013

a tough decision

It's time to get a job. As someone who is far more comfortable when a plan is in place, I feel almost suffocated by the decision needing to be made in front of me.

I should count myself fortunate in that I have options, and they are good options. I had three offers and narrowed the decision down to two.

Option #1 is with a small practice in our current town. I could work 70% for a wonderful boss who was one of my mentors during fellowship. He allows his physicians significant flexibility in how they structure their work days. You have to see your patients, but how you do it is up to you. Call would be frequent, but reasonable and fairly quiet. I would be working with a close friends, who graduated fellowship last year. The facility itself is one of the best run and managed hospitals I've ever seen with a staff dedicated to professionalism and superlative patient care. We could stay where we are, buy a house, and send our kids to the excellent local public schools, one of which offers language immersion (for free!). We could continue in the social lives we've created here and watch our kids grow up with the children of our now-very-dear friends. At 70% I would have one day off and four shorter days, which is going to be important when Munch starts kindergarten next year.

Option #2. Move home. I grew up 600 miles away in a town that I still love. My parents, my sister, and my brother-in-law's family (with the only two cousins my kids have) are all there. My mom is retired and wants nothing more than to take care of her grand kids. The job would be very different. A large group with a strict "no part-time" policy. I would have almost zero ability to leave early for kid-needs, whether they be scheduled or urgent. The group itself is in the middle of a tremendous upheaval and has turned over most of its nursing and support staff. Many of MDs have left or are in the process of leaving, although I liked the "new hires" who I met during the interview. Call would not be as frequent, but busier. I would make more money, but we would probably spend that money on private schools.

Part time work would mean more time for kids, less stress, and less money. Moving home would allow us to access a fully reinforced support system, which could itself make full time work easier.

I also just want to live near my family again. I hate traveling for every holiday and missing birthdays. I want my parents to be a part of my kids' everyday lives instead of the sporadic treat-and-present-filled bursts that now form the basis for their relationship. My husband is equally conflicted. He wants me to work part time but also would prefer to live close to family. Work-wise, it would also be better for him if we moved.

I've come to only one definite conclusion in this week of insomnia-inducing mind contortions - I can't predict what is going to be best for my family 5 or 10 years from now. I can made this decision based only on what I think is the better option for the next few years and hope that if I need to put us on a different path, that path is either available to me or I am capable of making a difficult decision. 

We are moving home.

Saturday, June 1, 2013

Mother's Day, MiM-style

Mother's Day this year was my favorite one to date. It involved working for 7 hours at the hospital, so maybe my expectations were low that it would be one for the record books. (I had traded teams with another attending in order to get the weekend before - daughter's first communion - off, but that meant being on for Mother's Day.) Instead, I was pleasantly surprised.

8:00 am. Enter post-call team's room  - an all-woman team with resident, 2 interns, and 1 third year medical student - bringing breakfast (nothing worse than being post-call, hungry, and not having food) - and I'm met with a chorus of "Happy Mother's Day!" None had families of their own yet, but they knew about mine. Before we launched into patient presentations, they wanted to know about how my family fun 2 K run went the day before since I had warned them that if I didn't show up that Sunday, it would be because I had died from attempting to run that thing (Not a runner. Usually break things when attempting to run.) We round, take care of our patients. I write my admission notes and head home.

4:00 pm. At home, Girl (8) and Boy (5) have prepared a Mother's Day show. Boy2 (2) is an unpredictable assistant. There is a ticket booth with tickets and an information sheet informing us that we should expect to arrive between 4:00-4:15pm and the last time to get there is 4:15pm.

We all go upstairs into Girl's room and me, husband, and our awesome au pair M are seated in a row of office and desk chairs facing Girl's bed. She reads from a script.

"Ladies and gentlemen, boys and girls, before we start the 3 songs, I would like to talk to you. Over there near the bounce area, you can get raffle tickets. There are only 27 raffle tickets. You just ask for a number of tickets, I hand them to you, you sign your name, and hand them back. Then at the end of the show, I will pick the winner, give them artwork and they will keep it. I also have artwork for KC because it is Mother's Day. Now, if you are wondering where the bounce area is, it is there. (points to corner with many random pillows and blankets). You cannot get all the tickets. The most you can get is 6 raffle tickets. Boy, '1' please."

Boy runs to the CD player and starts the first song of the Holiest Kid CD Known To Man, a CD given to Girl by her first grade teacher at the end of last year - very holy bible songs in surprisingly catchy tunes - this CD deserves a post in itself. Girl, Boy, and Boy 2 stand on the bed and sing and perform. It is achingly cute. (and holy).

"Thank you, thank you. (bow)" repeat x 2 other very holy songs.

At the end, I won the raffle AND got special Mother's Day artwork. Score!

"The show is over. You can play on the bounce area or leave. Thank you for coming. You can also take one of the dolls on the floor, but not Rebecca or Baby Boy, they are my favorite. Thank you!"

7:30pm.  I am walking into Verizon Center arena with Girl for her very first concert. Taylor Swift. This is a birthday present for her, but I am secretly very psyched. It's been ages since I've been to a concert. Girl is a Daddy's girl through and through. I'm usually assisting our boys (very much Mama's boys) and the husband, her. This time with her feels very special. She is BEYOND EXCITED. Half walking-half running ahead to find our seats She screams and sings along to the songs. Watching her experience the concert fills me with joy.

Taylor Swift is fantastic. Such a great, entertaining show. The best concert I've ever been to by far. (OK, maybe not saying much given my track history - not telling - but let's just say the concert that's a distant second was Madonna's Blond Ambition tour, complete with her torpedo bra outfits. Much less family-friendly.)

11:00pm. We finally get home after the drive in from the city (and leaving before the encore - tomorrow is a school day) and get her quickly ready for bed. It's going to be a rough morning.

It was a full day, a  day of work-life on steroids. And completely awesome.