Thursday, March 31, 2016

Surviving long distance

It's been awhile since my last post so a quick update before I go into this topic. I am currently 11 weeks away from finishing my radiology residency! I will be continuing on at my home institution for my breast imaging fellowship. My little C just turned 3 in January and is doing very well in pre-school (and an update to my prior post, she is finally pooping in the toilet!! It turned out she was just very stubborn and decided one day to do it and never looked back.). My husband big C is finishing up his fellowship in spine surgery on the east coast and will be coming back home at the end of July. He got a job on the west coast, which is about 2 hours north of my home institution so we'll be doing another year of "long distance" but I don't consider a 2 hour commute "long distance" after a year of "west coast and east coast, 3 hour time difference, and 2 flights and a layover to see each other long distance."

I am by no means an expert on long distance relationship and this year has been my first year of ever being in a long distance relationship. I was definitely a hot mess for a good part of it but now that we're less than 4 months of it coming to an end, I am starting to see the light at the end of the tunnel and wanted to share how we, me and little C, survived a year alone.

1. Communication. This is the biggest part of any relationship especially in a long distance relationship. Big C and I talk every single day usually via text message. It's hard at times especially when he is doing a 9-10 hour case but he always manages to text me in between cases. It's important that we check in on each other and know what we're doing even thought there is an entire country in between us. This is our way of maintaining our adult relationship and marriage because when we do FaceTime in the evenings, we try to make it about little C. Usually from the hours of 6 to 8 PM (west coast time), we have our FaceTime on. We usually aren't talking the entire time but big C is able to see us eat dinner and our usual bedtime routine. This way little C gets to at least see her daddy almost every day. No matter how busy we are, we always check in on each other!

2. Don't forget about the light at the end of the tunnel. I am guilty of forgetting this at times. As a single mom this year (minus most weekends when we go an hour north to my parent's house), my days just revolve around surviving. I am just trying to make it to bedtime but it's important to realize that there is an end goal. There is reason why we are doing this. It's easy to get caught up in the stressful moments but whenever I am feeling stressed, I think of our family living under the same roof once again and being able to provide for little C all the things we talked about and hoped for in the near future and the stress does melt away some. It definitely helps to know that it is only temporary because there is a bigger picture in mind!

3. Making each moment count. I am not brave enough to travel with little C alone to the east coast, mostly because where big C is training, there is no direct flight and it's a whole day ordeal to get to his place and his place = bachelor's pad. I've been out to the east coast a couple times this year when my mom graciously watched little C. We didn't get much sleep but in its sacrifice, we got to treasure these few days of adult time and made memories to last us to the next visit. When big C visits us here, which is about once every 6-8 weeks, we will fill every minute with family time for little C whether it be going to an amusement park or something as simple as going to the playground. We just strive to create memories and experiences for little C as a family of three.

4. Be considerate. Sometimes it's very easy in a long distance relationship to get caught up in your own life that you forget to think about what it's like to be in your partner's shoes. I am very guilty of this as well. I often lash out at big C about how he has no idea what's it's like to be a single parent doing residency.  But at the end of the day, I am so grateful I get to snuggle little C in bed and how she gives me 3 kisses, 1 on each cheek and 1 on lips right before bed and she calls me her favorite. I get to pick her up from pre-school every day and I get to come to a home filled with pictures and memories of our family. There are hard days but I am not alone. I remind myself that he might not be here but he has his own battles. He lives alone and away from his family. He's experiencing a rigorous fellowship that often involves 5AM days that sometimes end at midnight. He's on call constantly. All 3 meals are often from the hospital cafeteria. He's in a new environment where he doesn't know anyone. And at the end of the day, he's not just doing this for himself. He's doing it for our family and for that, I am truly grateful to have such a hard working, selfless husband.

5. Make short-term plans. This was more relevant when we first started our long distance relationship. I would make a big deal at each 10 week mark. I still continue to make a big deal for each time he gets to visit. There is a light at the end of the tunnel but we still need something to look forward to get through the day to day. Now, we're days away from April and making plans to attend each other's graduations. I still can't believe we have survived this far!

Doctor Day advice

The teacher at my younger daughter's preschool says that they're going to start a unit on different careers, and she asked me if I could come talk to the kids about being a doctor. Of course, I said yes.

While I did this once before for my older daughter's class many, many years ago, I feel like recently what I do has diverged significantly from what little kids think of when they think of a doctor. I still have the equipment, but I can't even remember the last time I took someone's blood pressure. (And that person was probably my husband, who is always convinced his BP is high.)

Has anyone else done a Doctor's Day for your child's class? If so, what did you do? What was a big hit?

Thursday, March 24, 2016

The Most Intimate of Jobs

A random Saturday earlier this month marked the first time I provided sedation anesthesia for patients in the same IVF clinic where I was a patient for 3 years. It was surreal and a little emotional driving up the hill to the clinic and thinking about the many times I went there as a patient myself. All the shots, the blood draws, the ultrasounds, the procedures... Also all the letdown and disappointment that was flanked before and after by hope and excitement. I now have a beautiful baby girl to show for my time as an IVF patient!

A friend of mine who is also in the medical field said to me, "I bet it took a lot of courage to do that. Creepy and scary". While I instead had viewed the experience with gratitude and excitement at the ability to give back to a group of people who had given so much to me, I can understand what she meant. As physicians, we are faced with daily reminders of unpleasant things. Things that have happened possibly to us or to our loved ones, or things that are at the very least reminders of our own mortality.

I think these reminders are a gift, one that doesn't come with many other lines of work in this world. They keep us appreciative of what we have, what we've been through. Has anyone else had an experience like this in their practice? Share your thoughts with us.

I matched!

Match Day has come and gone, and I have to admit that life looks so much brighter on the other side of that big white envelope. The months leading up to last Friday have been filled with more ups and downs than I care to count. I know I'm not alone in feeling grateful that the entire process of residency applications, interviews, ranking programs, and waiting, waiting, waiting is finally over!

Now that I've got that Match letter in hand, telling me that I matched at my first choice program (my home institution - hooray for not having to move across the country with a toddler and baby-on-the-way!) I am feeling humbled, grateful, and honestly somewhat astonished to be at this point. There have been so many times in the past 4 years that I wanted to walk away from medical school - studying for Step 1 while trying to conceive, battling first trimester nausea during my surgery clerkship, leaving my baby girl in the care of others when it was time to return to rotations, pumping when I'd rather be nursing her, hearing from my husband or mother-in-law or babysitter about the milestones she reached rather than experiencing them first-hand, tiptoeing out of the house before she awoke in the morning and coming home long after she'd been in bed...the list could go on.

But I count myself blessed to have had the support of my husband, parents, in-laws, and wonderful community of friends during this time - I know from reading this blog that many mothers in medicine are shouldering far heavier burdens with far less help. And it's largely because of those supports that I made it to Match Day. They are the ones who listened when I was frustrated, cared for me when I was exhausted, and lifted me up when I was discouraged. They are the ones who made sure that my daughter always had a safe and nurturing environment to be in (and that mama always had plenty of pictures to keep her going through the longer days and nights). My Match Day belonged to them as much as it did to me.

Even though we are staying put for residency, there are big changes on the horizon. I am thankfully finished with all of my clinical requirements for medical school, but there are all those little administrative odds and ends to take care of. And Baby #2 is due in less than 5 weeks! I still need to dig out the newborn clothes and bassinet from the first time around, maybe review our birth plan/what to expect during labor, think about preparing some food for after the birth (emphasis on think about rather than actually prepare) and pack that hospital bag. Now that the stress and excitement of the entire Match process has subsided, I'm grateful to have the time to prepare, physically and emotionally, for our transition to a family of four.

Congratulations to all the other medical students out there who matched last week - I hope that you are enjoying some well-deserved relaxation after passing this milestone in medical education! I know that Match Day is not necessarily a joyful occasion for everyone, whether it be due to an unexpected placement or not matching at all. So to anyone who is not celebrating this year, I wish you strength and courage for the discernment that lies ahead.

Please share your own stories of this Match Day and those past!

Monday, March 21, 2016

I'm a grown woman and my work bag needs to represent that

What do you do to celebrate yourself? How do you toot your own horn?

I am a part of several very lively on-line support groups for mothers. I love many of the posts and I have especially started to really enjoy the posts that talk about how busy mothers reward themselves with things like fancy purses, fabulous trips and paying off their loans. I don’t think we do as much as we should to celebrate ourselves, to be gentle with ourselves, to love up on ourselves. After the first 8 months of being an Attending, I sometimes realize that besides going to the gym I haven’t done a single good thing just for myself in a week; that’s when I schedule an eyebrow shaping or pedicure appointment (I am overdue for both by the way, uggh!). I am going to start with the purse, build my way up to a trip next year, and before turning 40 - these loans will be paid off!

Back to the bag - the work bag my mother bought me at the beginning of residency has been through a lot. It’s a nice, large personalized LL Bean bag but it has begun to look weathered and frayed. I’m too young to look sloppy and unkempt and I need an upgrade. I went out with some of my Sorority Sisters recently and I noticed how all of the Lawyers had beautifully sculpted, supple leather bags - they were gorgeous! 

That’s when I decided - I’m upgrading myself as soon as I get my first check from my new position (more on that later). My budget is modest and several friends recommended Coach (my favorite is the Coach Mercer Satchel in eggplant) due to their durability and timelessness and some sister-doctors recommended the Dagne Dover (I like the roomy Charlie Tote the best). And now I’m ready for my own, not-a-hand-me-down, grown lady work bag. One that I’ll feel like singing Beyonce’s “Grown Woman” out loud as I carry it into my new office. 

Any recommendations for your favorite work bag or purse? One that will not be flashy while commuting on the DC metro? One that will allow me to easily go from work to picking up Zo from kindergarten?

Thursday, March 10, 2016

Money Talks

I've been reading The Grumpy Rumblings of the (Formerly) Untenured blog lately. Their personal finance posts make me kind of uncomfortable because I don't think we've done a good job of planning or saving. We're not frugal and we haven't paid down our mortgage (although we did refinance to shorten our term) and we won't be able to retire early. Which mostly I think is fine...except when I read their posts.

But anyway, I read this post about how we communicate about money and I commented. Sam and I communicate fairly easily about money; we discuss major decisions, we have similar values, we have enough money so that we can each buy the things we want. I'm not surprised to read that money is a source of conflict for a lot of couples, or that one member of the couple manages the money. I was astonished to see how many commenters say that they give their partner an "allowance". 

I give my daughter an allowance. I had an allowance when I was a child. I don't give my husband an allowance and he doesn't give me one. I understand the value of having money you can spend without accounting to your partner for every penny, and I can see the reasons for deciding ahead of time how much that will be each month. But an allowance? As an adult? That just rubs me the wrong way.

Is it just me? Do you have an allowance? Do you give your partner an allowance (if you have a partner)? Am I completely over-reacting to a perfectly reasonable word?

Wednesday, March 9, 2016

MiM Mail: Share your anecdotes about pregnancy and maternity leave

Hi fellow mothers in medicine, I'm currently a resident and pregnant with baby #2. I must say that the attitudes I have encountered throughout this pregnancy from my attendings and peers have been discouraging. I'm working on writing an op-ed piece about attitudes toward pregnancy and maternity leave among US physicians and would love to have more quotations and anecdotes from your experiences. Positive and negative comments are welcome (please comment below)! Sadly, mine have been mostly negative. Thanks so much!

Saturday, March 5, 2016

Conversations With My Daughter

A keeps telling me what to do. She's so mean. It's like she's my mother.

Hey. I'm not mean.

True. It's like she's the mean mother I never had. Why is she so mean, anyway?

Well, honey, you know her better than I do. It sounds to me as if she's really insecure and also pretty envious of you and C.


You both have a lot more money than A and her family. You two get to travel and buy pretty much anything you want. A doesn't.

I know. And I don't know why she's so mean to her mom. Her mom works really hard. I think she's nice.

She is nice, and she is working really hard. I can't imagine how painful it must be to have to tell your kids you can't afford things they need. And, at the same time, she seems to tolerate B being mean to her. You said once that you knew I'd never let you talk that way, and you're right. I wouldn't.

It would never even occur to me to talk you like that. Or to yell at you that way.

I know. And a lot of that is just the way you are - the way you're wired. Some of it, though, is that Daddy and I have been clear about what the limits are. And we've also treated you like a human being. We've listened to you and explained why we make our decisions and we respect you and your point of view, so you trust us to be reasonable.

Yeah. And then I expect everybody to be like that, and they're not! Other people are NOT reasonable. Like, I keep thinking people will apologize when they've done something wrong, the way you and Daddy do. And they don't!

Tuesday, March 1, 2016

Let the Mystery Be

Our little man will hopefully make his appearance (hopefully in a much shorter and less painful way!) in the next few weeks… I hit 37 weeks a couple of days ago, and for me, this is uncharted territory as I went into labor with our daughter at 37 days on the dot. This has really felt like a milestone- as residents, we live our lives in month-long blocks, and the past two blocks have been the most intense physically and hours-wise rotations we have in our pathology program. We're all still in one piece though, and for that I am grateful. We met with our volunteer doula this past weekend, finally acquired a car seat, and took inventory of all the leftover clothes I had stashed from my daughter (mostly gender neutral, thankfully!) that we’ll be able to use again. This is finally feeling like a reality.

I wanted to share the strangest experience I had this weekend which I haven’t been able to shake. I’m sure many with multiple children relatively close together can commiserate over how different subsequent pregnancies are from the first…  Beyond our work, our focus has been survival and spending as much quality time as possible with our daughter and being a family of 3. It’s been easy to forget about the pregnancy, and actually I’ve done a pretty good job at ignoring it so I don’t worry haha.. But this time, there have been no photo diaries week by week, no journal entries to my fetus, no shopping trips to buy anything special.

One experience we really treasured the first time around was going to one of those recreational 4D ultrasound places to find out the sex and see her face. We actually went twice- once around 15 weeks and once later on, maybe 25 or 26 weeks. I remember how much we stared at those photos- we even had one framed which I brought to my delivery haha. Her face was so beautiful... I still love looking at those photos in utero and seeing her face in them, her little button nose and full lips. Anyway a couple weeks ago, while feeling guilty realizing how little time was left and how little we had done, my husband and I decided to try to find a similar U/S place in the city we live in now. The place with the best reviews was far- over 30 minutes away- but we thought we owed it to our fetus to be appreciated for a morning and to let our daughter see him, haha. But it was actually disappointing… it was sort of a weird sterile office, not at all a warm fuzzy baby-friendly environment like we experienced back in California. Also, previously, we had to sign that we were receiving prenatal care and write down the name of the hospital and Ob practice in case there were any abnormalities that needed to be reported;  at this place, all they took was our name and EDD. And unfortunately, our little guy was totally covering his face with both hands and feet at the session, so they invited us to come back for another look in a couple weeks.     

So this weekend we went back to test our luck, and while in the waiting room, the doctor/owner of the business (radiology IMG, not practicing here; his wife seems to be the ultrasound tech) came out and asked if I could come help him with translation issues with his current Brazilian client that couldn’t speak English. He knew I had an MD, but I was caught off guard. Without thinking too hard, I shrugged and said, sure, I only had patchy Spanish and Italian to offer but maybe it could be a bridge to their Portugese. I entered the room to find a young couple with their two older sons, maybe 7 and 9. The woman looked scared. I started to feel scared. According to her LMP, she should have been around 10 weeks along. No cramping, no bleeding since. Regular periods prior. Apparently, no insurance and she hadn’t seen an Ob or PCP- only positive HPTs. The problem was that no heartbeat was detected, and she was measuring only around 5 weeks. My heart sank. It was clear they had all come to share the joyous occasion of seeing the baby for the first time as a family. I was so sad for them as I had been in the same position a year prior, the ultrasound planting the first seed in my heart of the possibility of miscarriage to follow. We tried to explain as gently as possible that time will tell whether the pregnancy will continue. But I was upset that I was in this unexpected position. I was upset that she didn’t have a doctor of her own. I was upset that she was receiving this information in this setting. I tried my best to encourage her to establish care with an Ob as soon as possible, but it seemed unlikely that it would happen.

I keep thinking about her today and wish the best. I truly hope this is a dating issue and that her pregnancy will progress. I keep thinking of my own miscarriage, the ordinariness and near universality of the experience and how isolating, unique, and devastating it still feels. I think of the miracle of our family now ready to welcome a boy just a year later. Of all the health we take for granted. I think of the fragility of our children, that this is all the beginning… by gaining so much in love we also have so much to lose. But I remind myself that the alternative, of not opening our hearts to the potential of more love and family, is also a sort of loss. I was reminded of this old song by Iris DeMent, called “Let the Mystery Be,” which expresses her coming to terms with rejecting organized religion (she grew up in a big religious family I believe) in a really beautiful way... I often sing this to myself when I feel like I need to let go and not worry... so much unexplainable mystery in life.     

Here is the brief and only glimpse our little one gave us of his face in the two ultrasound sessions. He wants to stay a mystery and I accept that. I just can’t wait to kiss those chubby cheeks and lips and see what the rest of him looks like… well, maybe I can wait just a couple more weeks :)