Monday, July 21, 2014

I Spanked My Kid.

Genmedmom here.

I spanked my oldest last Wednesday. Twice. He's only four, he's autistic, and I hadn't seen him all day. I am such a jerk.

My day had started at five a.m. I had several extremely complicated and sick patients and several extremely complicated phone calls and a load of logistical paperwork and an inpatient to see and it was downpouring when I left work and I had to walk a mile to my car and the afternoon rush-hour traffic was standstill in the tunnel and I was forced to breathe car exhaust and I felt sick all the way to Nana's house blah blah blah.

I had been truly looking forward to seeing my little man and my little bug. But all the way to my mother's house (she picks the kids up from school/ daycare), all I was thinking was that I had to get the kids rounded up and in my car and back home for baths and bedtime, and I wasn't sure what time Hubby was coming home. I was stressed that I might be solo for the whole night-night routine (Panic!!!!)

When I got there, Babyboy had a poop and a terrible diaper rash, and he didn't want to be changed, so he twisted and turned, and he started grabbing things and throwing them at me, including poop-covered baby wipes, and I yelled STOP IT and swatted him on his butt. Then five minutes later he shoved a throw pillow at my infant niece, and I yelled THAT'S IT and I spanked him.

Now I feel terrible.

I've yelled and spanked before, and it always makes me feel like the most ineffective, inept, stupid, bad mommy. I intend to avoid this primordial parenting technique. But when I'm exhausted, and I can't seem to get control of my kids, I just get so frustrated and angry, and I can't seem to access any of the more advanced parenting skills I've read about.

And, spanking works. In the very short term. Very, very short term. Babyboy stopped throwing poopie wipes the first time, and he stopped shoving pillows the second time. But he cried and wailed for Nana, who never loses it and is always calm.

So, obviously not a great parenting tactic. And if my colleagues and patients saw me lose it and get physical over poopie wipes and pillows, I would be mortified.

The best book on parenting an autistic child that I have encountered so far has several wonderful lessons and suggestions on this very topic. I've dog-eared the pages and read them several times.

The book is Ten Things Every Child With Autism Wishes You Knew by Ellen Notbohm (Future Horizons, 2012), and chapter 9, "Identify What Triggers My Meltdowns" is applicable to any parent of any child who ever throws a tantrum for any reason.

She writes: "If you react with anger and frustration to your child or student's meltdowns, you're modeling the very behavior you want him or her to change. It's incumbent upon you as an adult, at all times and in every situation, to refrain from responding in kind. Be your own behavior detective. Figure out what triggers your own boiling point and interrupt the episode before you reach that point. When your thermostat zooms skyward, better to temorarily remove yourself from that situation."

In my case, Babyboy may have been overstimulated, and then protesting. There were many family members in the house and in the room; I had just arrived; the television was on; it was stormy outside... and I was pinning him down to the unpleasant and even painful task of a diaper change. When he acted out, I could have held in all my frustration, got the poop reasonably cleaned up, and put Babyboy in time-out in another room, away from everyone. That may have avoided the second outburst and spanking.

Of course, there are many people who feel that spanking is acceptable parenting behavior, and Ellen Notbohm has these questions for those folks:


Does spanking follow careful weighing of alternative responses and a reasoned decision that, yes, striking someone one-quarter our size is logical, provides a good example for them to follow, and will produce the desired long-term result? Can we be sure that it teaches the child what she did wrong?

Does it give her the knowledge and skills to correct the behavior? Or does spanking spring from aggravation, wrath and desperation?

Does it foster respect and understanding, or humiliation and bewilderment? Does it enhance the child's ability to trust us? Is it a behavior we want the child to emulate?"

Of course, this all makes perfect, clear, sane sense. And I've read it, and I get it. But in the moment, I haven't been able to consistently refrain from yelling and spanking. And I'd like to.

I think the real answer is in identifying Babyboy's triggers and trying to avoid them. In my case that day, there was an even better potential solution: I could have taken him to another, quiet room to change his diaper, and, after a bit of cuddly mommy time, I could have given him some control over the process, a job to do, like handing me the wipes or unfolding his clean diaper.

That response would have been ideal. It would have required some thoughtfulness, some space, some time.

As Ellen Notbohm writes, "Many will be the wearying moment when the root cause of your child's meltdown won't be immediately evident. There may never be a time in your life when it's more incumbent upon you to become a detective, that is, to ascertain, become aware of, diagnose, discover, expose, ferret out..."

As a physician, I am so accustomed to multitasking, problem-solving, wasting no time, get the job done... With Babyboy I need to slow down, breathe, and think. Study him, and anticipate the acting out, the outbursts, the tantrums, and steer around, or make them disappear. I do think it's possible...

Has anyone else out there had any similar experiences/ got any suggestions to share?

Thursday, July 17, 2014

MiM Mail: Disclose family in residency applications?

Dear Mothers in Medicine,

I was so excited to have found this blog! What an inspiration! I'm a 4th year medical student with a busy little 12 month old. My husband is wonderfully supportive and great at stepping up and taking care of our son when my schedule gets crazy. To be honest, when I first found out I was pregnant I would have never thought that med school + a baby would be so doable (ridiculously hard at times, but totally doable). Sure, there were many times when I was ridiculously sleep deprived and didn't get to see my husband or baby awake for a day or two. And sure, there were several times where I spent my pumping session crying in addition to stuffing a sandwich into my mouth as quickly as possible. But I did it, and I *think* I did it well. I don't mind anonymously tooting my own horn on this one because I'm darn proud. This past year has confirmed that I'm on the right track-I love being a mom, and I love being in medicine!

I am now preparing to apply to residency positions. As much as I tried to like a field with more potential for control over my schedule (peds, PM&R, pathology?), I realized that I would never be satisfied if there wasn't a significant amount of OR time in my future. I even almost let a few of my attendings talk me into going into general surgery, but in the end I decided that my passion is for OB/Gyn. I'm struggling with this decision because of the many hours/days that I know I'm signing myself up to spend away from my family. My husband tells me that I can always quit and be a SAHM, but that is not my calling and I know it. I'm already feeling guilty about putting my career in front of my family and now I'm faced with the decision of whether to disclose in my applications that my family even exists! I've been told that when selecting residents, if two applicants are otherwise equal, they will pick the one without commitments outside of the hospital. It's illegal, of course, to base decisions on these factors, but it's undeniable that it happens.

I think I've decided to leave any mention of my family out of my personal statement, but there are many other areas in the application process where this information could potentially come out. There are two different areas for explaining any breaks and extensions of the normal 4 year track. I took a LOA after I had my baby. Do I just say I took a medical leave and not explain? Is this a red flag? (Is this going to happen again? What if it was a psychiatric reason and she's unstable? Etc) I have heard of people bringing their kids/spouses to interview dinners. Do I leave them behind? Not talk about them? Hide my wedding ring? How far do I take this? It just feels wrong to hide the two most important and influential people in my life. I used to think that if a residency program doesn't want me because of my family, then I don't want them. However, in an increasingly competitive market, it may be naive and foolish of me to sabotage myself by disclosing personal information that won't even potentially benefit me. It just all feels wrong.


Monday, July 14, 2014

Rediscovering quantity time

It's an old question: quality vs quantity time? When it comes to parenting, the people whose lives allow for quantity tend to argue in favor of quantity, while the people with less quantity argue for the importance of quality. Which is not to say of course, that you can't have quality while also having quantity. In any case, in the Mommy wars, its one of those false dichotomies likely to provoke a melee of defensiveness and self-righteousness.

I started my life as a parent with six months of quantity time. I took 8 weeks off, but then worked part-time, mostly from home. My daughter and I were together almost all 168 hours of the week. We marinated in each other. We stared into each other's eyes for long stretches. Most of the time, neither of us was fully clothed. I was engaged in elaborate procedures to increase my milk supply, so I was either nursing or pumping or nursing-then-pumping every 2-3 hours around the clock, and my daughter was never more than three feet away from me. There was no day or night, just a repeated cycle of hunger, contact, cooing and shushing, punctuated by the pchika-pchika-pchika of my loyal pump. I tried to work when I could. 

Then I started residency and parenting changed completely. Now the demands of my job were absolute, predictable down to the hour for an entire year in advance. I had to be fully available at work and so my partner took over the job of being fully available at home. My daughter started day care and began to adhere to a more consistent bedtime. Instead of working when I could, I had to parent when I could. Many days I had only half an hour or an hour with her before bedtime and I learned to make these minutes gleam with high octane focused attention. Then there were golden weekends, unexpected early days, vacations, and continued nighttime awakenings, which killed me but also kept me going. We cuddled as much as possible. When people lamented to me on behalf of my daughter about my demanding schedule and how little time I was able to spend with her (frequent occurrence), I gently told them how proud I was of the quality of our relationship despite these constraints. I didn't exercise, travel, or buy a new pair of shoes for two straight years but with what time I had, I parented with my whole heart. 

Now I'm a third-year and it's not feast or famine anymore. I can eat breakfast with my family, put in a solid work day, then eat dinner with my family. And weekends are back (sometimes). The timing of this detente is coinciding with a leap on the part of my now two-and-a-half year old towards more independence and awareness and conversational ability. To celebrate, I took her on a road trip to see her grandmother in Vermont. We were in the car for fourteen hours in total and I gained a new appreciation for the things that quantity time can give you that quality time cannot. There was a period of twenty minutes in which she screamed "Mommy, I want to poop in the potty!" at top volume and I thought I was going to lose my mind. Then I figured out a tickling game we could play while driving and the car was filled with both of our giggles. We slid from mutual frustration to laughter to boredom to song to negotiation then back to boredom then back to jokes. It's not that these transitions don't happen over shorter stretches but with 72 uninterrupted hours ahead of us, I didn't feel pressured to make every moment fun. I didn't feel pressured to entertain E. We were just inhabiting time together, without bedtime or daycare drop-off or a specific activity to get to. E asked lots of ontological questions like "Mommy, who is your Daddy?" and "Where are all these cars going?" When we stopped for lunch, she laid out her chicken nuggets and french fries in a perfect straight line and said in a matter-of-fact voice, "Nuggets and sauce is my favorite. What's your favorite?" It felt like we were on an epic date, complete with some long silences and surprising moments of synergy and a sense of time without limit.

Like most of the issues in the Mommy wars, there is no one right truth for anyone and on average the truth is somewhere in the middle. The truth also changes. Parenting with limited time taught me mindfulness and focus and priorities. It made me a better parent. Now I'm looking forward to spending longer stretches of less goal-oriented time with E. I'm hoping to build a life in which quality is the focus both at work and at home, with enough long weekends and road trips and lazy vacations in remote places to marinate in timeless time together.

Thursday, July 10, 2014

MiM Mail: Keeping the relationship strong and resentment to a minimum

I am a third year medical student who recently had a child and am starting back on the wards soon, after a lengthy maternity leave.  I experienced some of third year already (while doing rotations during my pregnancy), and I'm absolutely terrified about going back!  Nope, it's not about the rigors of the wards or balancing school and medicine (we have older kids so I've done some of that already).  I'm terrified of the resentment my husband is likely to feel while taking care of the kids for such long hours on his own while I'm away and also while I'm studying.

He fully admits that he felt some of that in my first and second year and knows he'll feel it again when I go back since the hours will be longer.  To those in med school, residency, and practicing--what did you do to keep your relationship strong when your spouse often feels like a single parent?  I plan to do as much household stuff as possible, find some extra childcare for a few hours on the weekends when I have tougher rotations, try not to complain, and try to book family time for at least a little almost every weekend.  Any other ideas?  What works for you in this regard?  Thanks so much for any advice you have!

Tuesday, July 8, 2014

Guest post: Pregnant during residency (and not feeling the love)

Prior to becoming pregnant I thought there were no women's rights issues in today's day and age. It was only after I became pregnant that the struggles became all too real. One of the first questions I received from my program director upon announcing my "good news" was...will you take all 6 weeks? Soon afterward a colleague proudly told me he once worked with a resident who was back to work 2 days after delivery. He was hoping my pregnancy would be uncomplicated so I could do the same. Approximately 25 weeks into my pregnancy my physician said I could no longer work solo 24 hr in house calls or 80 hr weeks and that although I could continue my rotation duties, hours should be limited to 12 hr shifts, 5 days a week, maximum of 60 hours. This restriction came after early contractions, shortness of breath and tachycardia had set in.

Although my colleagues weren't pleased with this decision, they agreed to accommodate me of course with the assumption I will be heavy back loaded on calls when I return from maternity leave because each and every hour of call I miss needs to be made up. Made sense to me since caring for a 3 month old should be easy peasy right?

In the meanwhile I continued to work, study, do research, present at national meetings. Pregnancy brain hasn't always helped while being pimped or taking my yearly shelf exam but I have dealt with it as best as I can.  After receiving  two offers for prestigious interviews at two of the top programs in the US for my subspecialty my program director kindly contacted me to recommend that I not go to these interviews and postpone them in the interest of my health and since my schedule was already so "limited". I thanked him for his concern but went to the interviews anyway while 29 weeks pregnant and was accepted by both, able to have my choice!

Now with only 4 weeks of pregnancy left, my physician has recommended no more calls. I of course have worked with my colleagues once again getting them to cover my remaining calls with the promise that I will owe them all back.

I feel a bit like an outcast of the program right now all because I am trying to balance work with a future family. I hesitate strongly to say I am discriminated against but in some senses, I can't help but feel this secretly as well. I keep telling myself that this too will pass in hopes of things returning to "normal" after the pregnancy.

Has anyone else had similar experiences in pregnancy and if so, how did you deal with them?

-An ophthalmology resident 

Thursday, July 3, 2014

Play dates: Mothers in Medicine Style

Most of the Mothers in Medicine contributors, including myself, write anonymously. I write about my husband O and my son Zo knowing that folks who know me can figure out pretty quickly who I am. I write as if my boss is reading my posts, though I have never actually told her, but just in case, I write as if she may read them, nothing too embarrassing. I write to share and get feedback from folks near and far who understand my struggles and my triumphs in ways that my non-physician family never truly will. I have been writing for MiM since I was a Medical Student and over the years I have started telling folks beyond my family to check out my posts including some trusted work colleagues.

Over the years, I have felt like I have come to personally know many of our regular contributors and even a few of our regular commenters. I hope that someday there will be a big Mothers in Medicine Conference or maybe just a gathering at a bigger annual professional conference. When I read Cutter’s posts I said, hmmmm, I think we work in the same hospital! Flash forward to several months later (and many thanks to KC) and Cutter and I had our first MiM meet up at a local museum. Her daughter is super duper cute and Zo was smitten at first glance. He quickly followed her to the slide and then he began chasing her around the exhibits.

Play dates are always good times to reflect on the joys and vent about the struggles of motherhood, but when the other parent is a MiM, it is especially cathartic. Cutter is amazing. Chief Resident, Super Mom/Wife, super hair braider (from Youtube videos nonetheless). We spent hours talking and it was so nice to have someone who understands the doctoring and the mothering because it makes for a really unique life.

I have had a few other play dates with women Doctors including several with a beloved Attending who has young children. These times are equally amazing. She has the wisdom of being several years out of residency and fellowship. The first time I asked her and her kids out for a play date, she gladly accepted. We met up at another local museum and the next time at a park. Each time there was a lot of her being a cheerleader, saying “You’ll get through this.”

Play dates with stay-at-home mothers usually involve looks of pity and many exclamations of “I can’t believe you work that much.” Play dates with 9 to 5 working non-physician mothers usually involve less pity, but still many “I can’t believe you work that much” looks. There was none of that at our MiM playdate and I liked it!

Here’s to many future play dates, MiM style!

Tuesday, July 1, 2014

Happy Doctor's New Year!

It's here! The first day of the golden year of residency. The last year of residency.  I can barely contain myself! As we all said our goodbyes to the graduating residents yesterday, I felt a pang of resentment... That they are leaving us, leaving me.  Then I remembered that this indicates the end of my torture and the start of a new life.  I hope.  I hope, I hope.

Waking up this morning, I remembered the morning of my wedding day.  I had just woken up bright and early when I saw my hair stylist drive up and park her car.  I ran downstairs to open the door but my mom beat me to it.  When she walked in, I started jumping up and down out of excitement.

I'm not jumping up and down today... But I kind of feel like it!

Happy new school/residency/work year to all of you who live by the July 1-June 30 year!