Thursday, September 29, 2016

Pump Love

A Love Letter to my Breast Pump*

When we accidentally met many years ago, I had no idea how our relationship would become such a central part of my life. As a na├»ve and very poor medical student expecting our first baby, I scoured Craigslist every few days looking for free baby gear. I remember the brisk foggy morning when I saw the ad for you, the cozy pink oversize shirt I was wearing, how I was rubbing my mini-belly in the breakfast nook in our San Diego cottage. “Near-brand new Medela Freestyle breast pump, accessories, extra bottles, drying rack, etc. FREE to a family in need.” I had no idea what you were, but I knew a breast pump sounded like something I could need. I googled the price. WOW. This was being given away for free??! I quickly responded with my plight- a poor medical student married to a poor postdoctoral fellow (sounds like we shouldn’t be having a baby haha). The poster responded a few days later saying that she chose ME- what luck!- and before I knew it I was driving 45 minutes north to pick up the gear.

She showed you to me- you were surprisingly small and pleasantly yellow. You sat in a shopping bag with a ton of other accessories I had no idea about. With her infant in tow, she patiently explained to me how the pump worked and how she had to switch to renting a hospital-grade pump due to a dwindling supply. I nodded sympathetically and smiled, having absolutely no clue what she was talking about. I felt like I had somehow won the jackpot. We returned home and you sat in that plastic bag in a closet for the next 6 months.

A few weeks after baby’s absolutely chaotic arrival, near-delusional with sleep deprivation/exhaustion and with Step 2 CS around the corner, I remembered you and decided to take you out. What in the world? These funnels go over my tits?!? I googled videos. Ouch! I realized new tubing needed to be purchased. I searched “Medela replacement tubing” on Amazon and a day later new tubing arrived. It most definitely was not the right kind. I started crying and delegated the task of getting the pump sanitized, functional, and figuring out how the *&!@ it worked to my poor husband.

I remember the pride and wonder I felt when I finally tried you and could actually see the milk coming out- it had been such a mystery how much volume was actually being consumed by my little girl. All this fluid is being produced by my boobs?!? Wow! Step 2 CS came and went, with my first taste of what it’s like to pump in a bathroom. I went back to MS4 rotations, and quickly grew to appreciate your portability- your ever-lasting charge was a dream. I could pump in any old closet, exam room, or even in my car in the parking lot, at a moment’s notice. You even fit into my white coat pocket! The real fun began when I started interviewing for residency. I pumped on a crowded Amtrak, on the metro under a coat on the way to an airport, in random chief resident’s offices, and more. We got through it though. You never ever failed me, not once.

When my daughter turned one, you stopped holding a charge. I was sad, because I wasn’t ready to quit you. I had a backup pump through insurance, but when using it, all I wanted was you. With nothing to lose, I called Medela, and a very sweet woman listened to my plight (I left out the second-hand part, haha). Is there any way you could be replaced although I obviously have no proof of purchase?? A week later, a brand-new you showed up on my doorstep, which I packed away for my future baby.

Three years later as a pathology resident, you are still loyally by my side, helping me feed a new chunker. I have the luxury of more day-to-day consistency now, with a wonderful comfortable pumping room at my disposal. But I remember with fondness the crazy times we had. I can never express to you the invaluable gift you have given me, a precious breastfeeding relationship with my babies while continuing my life as a medical trainee. I have you to thank for the memories I will remember forever… ending long nights as an intern while sitting with my daughter quietly in the dark, silently reconnecting with her warmth and memorizing her changing face… being comfort for them when they are sick and need simply to nurse… the little starfish of a chubby hand reaching up for my necklace and resting lazily on my chest. My children have you to thank for all the immunity, comfort, and nourishment you have enabled. And my husband thanks you too for all the extra sleep he’s gotten due to continued nursing, haha. (But he doesn’t thank you for all the bottle and pump parts washing, especially living without a dishwasher.)

So thank you for everything, beloved breast pump. You have your imperfections, but so do I. To many more months of love to come.

*I have no relationship with Medela besides the one described here!!!
**It is NOT recommended to acquire breast pumps second-hand (although I will say that I purchased all new tubing, sanitized everything, and this one was only used a handful of times anyway. Still not recommended, I know!). Pumps are meant to be used for one year and not for multiple babies.

Bloggers block

When KC put out a call for contributors over a year ago, I barely hesitated to respond. MiM was such a refuge for me as I navigated new motherhood as a medical student. Medicine and family have both given my life such richness, so many highs and just about as many lows. I was eager to share my experiences with other trainees and especially to be an ambassador for pathology.

I forgot, however, that despite having the veil of anonymity, writing candidly and sharing is not something that comes easily to me. I am not cut out for this… I cringe at just about everything I write or say when re-visiting it later. Does anyone else struggle with this? We are very private… we don’t post photos of our children (or ourselves really) on social media, no pregnancy announcements, no baby showers, you get the picture… we even eloped at City Hall! I have really struggled to participate but I would still like to. I can’t tell you how many posts I’ve started but deleted. Those of you who are more prolific and seasoned in this forum- any advice for letting go of this paralysis? 

Monday, September 19, 2016

Living Your Questions

I’m sure you’ve heard Sheryl Sandberg's advice to women, "Don't Leave Before You Leave". Well, several years ago, I faced some choices. I had finished Family Medicine Residency the year prior. As planned, I did a series of temporary positions filling in for other doctors - the usual course of action for new grads in my field and location. These experiences were crucial in showing me the kind of practice style and environment I desired. After a year, though, I longed for "my" patients - to be able to get to know people, and follow them over time, both personally and clinically. It was unsatisfying to frequently step into a new clinic environment, never knowing how complete (or legible) the patients' charts would be, and never being able to follow a patient for very long.

Then, I filled in for a colleague's vacation at a great clinic and I didn't want to leave. Another doctor there asked for maternity leave coverage and I happily obliged. It was so refreshing: the clinic physicians were collegial, the staff was efficient and professional, and the electronic medical records system worked like a dream. The great news was that they had room for me to start a practice there. 

This idea daunted me: was I ready to commit to a practice? I wasn't sure, actually, because Family Medicine has its challenges and those that concerned me most were dealing with patients whose expectations greatly conflicted with what treatment I was comfortable providing, as well as assessments of disability for which I felt woefully untrained and unqualified.  I also had interests beyond clinical medicine - in academics, including medical education and research. Wouldn’t it be great not to be tied down? Many of my colleagues continue doing locums for years, and have great freedom and flexibility. Finally, my husband and I wanted to start our family: wasn't it foolish to start a practice when planning a pregnancy? I had uncertainties, and wasn't sure what was the best next step. 

I went for it anyway. I read and reflected on a couple of things: one, that I owe it to myself and potential patients to try practicing "real" Family Medicine. I knew it was the only way I'd find out whether I liked it. After all, having your own patients and directing their clinical care is so different than covering for another physician -- you set the tone of your practice. Further, I came across this powerful statement during that time - "if your next step doesn't scare you a bit, you're not pushing yourself hard enough”, which further reinforced my decision. This, I might add, is quite uncharacteristic for me - I am a very careful decision-maker. And the truth is, for the first few months, I still wasn’t sure that I had made the right decision.

Nearly six years later, I love having my own practice.  I get to establish a rapport with my patients, and partner with them on their journey to improve their health. I have been able to really delve into the problem-solving that makes medicine so engaging. I was also able to serendipitously find and develop an interest in refugee health.  Skill-building in this fairly new, actively growing field added another dimension to my practice, and allowed me to incorporate teaching with medical students and residents and involvement in community initiatives. 

As it turned out, it took my husband and I longer than anticipated to conceive. We are now grateful to have two young children, and I’m grateful that after each maternity leave I looked forward to returning to my practice. The experience of being completely unsure of my decision brings to mind these lovely words by Rainer Maria Rilke, which I first encountered several years before, during another period of uncertainty:

“Be patient toward all that is unsolved in your heart and try to love the questions themselves, like locked rooms and like books that are now written in a very foreign tongue. Do not now seek the answers, which cannot be given you because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer.”

Wednesday, September 14, 2016

Goodbye hormonal birth control

It’s kind of hard to say goodbye to hormonal birth control when it’s been so good to you for so long. I started taking the pill as a teenager. My father is a teen parent and my mother instilled in me such a huge fear of early pregnancy that I stayed prepared, mostly to avoid her wrath! Talk about the teen brain in action; birth control was a very concrete option. Avoid pregnancy or be beaten, possibly at school in front of all of your classmates. YouTube videos of parents beating teens wasn’t around then, but if it had been, I’m sure this nightmare would have included my Aunt videotaping and putting it on the Internet. (note: I am totally over-dramatizing this and my mother and Aunt are two of my dearest friends now. They loved me fiercely and kept me from all types of danger including a few college boyfriends who were up to no good.)

I still remember sneaking to Planned Parenthood (it was across the street from a busy metro station) in order to get my first pack of pills. I was sweating, I was scared. But larger than my fear of being seen was my fear of getting pregnant and having to tell my parents. I knew getting pregnant before college would make my dreams of becoming a doctor even more of difficult to achieve, if not impossible. I had my share of providers over the years. I remember one male doctor that tried to shame me by drawing horribly graphic pictures; I wanted to yell at him but was too scared. I remember some outstanding older nurse providers (one super cute grey-haired lady in particular) who were very sex-positive and helped me try various methods.

Methods I have tried to date (in semi-order): combined oral contraceptive pill for years, the patch for less than a month,  Depo-provera for a few months, abstinence, emergency contraception, pills again, the ring for a few cycles, the Mirena IUD for 3 years, a healthy planned pregnancy 3 weeks after discontinuing the IUD, breastfeeding and the mini progesterone-only pill for a few years, and finally my second IUD.

Somewhere around age 30 and my pregnancy, I began to have hormonal headaches each month around ovulation and changes in birth control. Now that Zo is well out of diapers, we are ready for baby number 2. So I said goodbye to my second IUD. Hubby and I decided this would be the end of hormonal birth control for us until we decide to have someone’s tubes tied. I am still holding out hope he’ll see me waddling around pregnant and will decide to get a vasectomy.

I know this country tends to shame sexually active teens, but I was one of them, and I turned out alright in my opinion. I’m a pretty successful Pediatrician, married, with a child. I have friends who used various methods and ended up teen parents and now as an adult I have countless friends dealing with infertility. I wasn’t promiscuous (though I won’t shame those who are), but I always knew that avoiding pregnancy and infection were top priorities for me (referring back to my mother who wanted no parts of being a young grandmother). Now that infection is virtually impossible (if anything goes down hubby will have some ‘splaining to do) and we actually want to expand our family, I say goodbye to my old friend hormonal birth control. Thank you for keeping me safe and allowing me to follow my dreams.

Monday, September 12, 2016

Are Mothers in Medicine Messier?

Genmedmom here.

I suspect that I'm like most docs, when I say it takes alot to gross me out.

And I wouldn't say that I'm messy, rather, I'm highly tolerant of messiness.

But this week, I wondered if maybe my threshold for disgusting is a little too high. Like, maybe there are some things so yucky, anybody should freak out and drop everything to clean it up.

Like this, for example. Check out the close-ups of the wall, soap dispenser and faucet handle:




This is our downstairs bathroom. Last weekend, the kids and I baked and frosted sugar cookies.  And, they also ate melty chocolate bars.

Both kids dutifully washed their  hands in the bathroom sink, which was left grungy with thick purple frosting and chocolate smears that then dried out.

What strikes me is that I used this bathroom every day between then and this past Thursday, and I didn't even notice this nasty crusting. It was right there, on the stupid faucet handle, that I touched, and it didn't even register with me. (Or my husband, for that matter.)

Yes, we are in survival mode most of the work week. Yes, we both have busy careers, and school just started, and our pets are demanding, and no one has a reasonable sleep schedule. But still. Honestly. This is revolting.

Is there anyone else out there who could have this palpable food residue all over their frequently used bathroom and not only not clean it, but also not even notice it for four whole days?

And, to top it off, when I saw this on Thursday, really saw it, I was literally rushing to pee before I had to run out the door to get in the car to pick up my kids from school. It was my day off from clinic, the mess finally registered with me, but I didn't even have time for a rudimentary scrub-down.

Thank goodness our cleaning people come Friday mornings...


Wednesday, September 7, 2016

10 myths about radiology

Hello MiM community,

It has been awhile since my last blog post. I graduated residency in June and I am currently in month 3 (where has the time gone?) of my breast imaging fellowship. I stayed in the same institution as residency for fellowship. My little C is less than 4 months shy of being 4 (!!). Big C finished his orthopedic spine fellowship on the east coast in July and after a nice 5 weeks of having a stay at home husband, he started his attending job in a city 2 hours from me and little C last month. It has been a busy summer!

I am currently surrounded by medical students applying to residency, which made me want to do this post. And now that I'm a PGY 6 in my radiology training, I think I feel somewhat equipped to dispel some myths about my specialty and I thought it would be a good opportunity to go into the medicine aspect of my life since most of my posts have been about my role as a mom.

1. We are anti-social. A huge part of our job is communication not just with patients but with other physicians. We talk to physicians from all specialties throughout the day. We often present at multidisciplinary tumor boards. I can't speak for all radiologists but the ones I work with and myself included, we are very extroverted and approachable!

2. We never see patients. This may be true if you decide to go into teleradiology post residency. However, during residency, we see patients all the time--whether it be giving results, scanning patients or performing image-guided procedures. As a breast imaging fellow, I spend half my fellowship doing mammographic-guided, ultrasound-guided or MRI-guided biopsies/localizations. In addition, we often have to speak to patients to relay biopsy results. There is the option to not see patients but this will not be the case during residency and the choice is always there for patient interaction post training.

3. We are lazy. Being married to an orthopedic surgery resident, I have the utmost respect for these grueling specialties. We may not wake up the hours of other specialties but we are definitely not lazy. The time we spend having to study plus the time we spend at the hospital would often sum up to 60-80 hours of week during the earlier years of our residency. In addition, our residency is 5 years plus an extra year of fellowship (which is typically not an option as everyone does a fellowship post residency.) Our radiology boards are 2 days--that includes 18 subsections including physics! The amount of reading on top of working in the reading room equals so many hours that we put in outside of work that most people don't realize.

= 4. We love sitting in a dark room all day, every day by ourselves. This is definitely not true especially during residency. Radiology is a unique residency in that we are often one on one with an attending all day, working together and learning from him or her. In fact, this also debunks the fact that we are anti-social as we need to learn to interact and get along with someone we work with all day. In addition, our dark rooms are often frequented by visitors usually in form of clinical teams and occasionally patients.

5. The job market is horrible and no one can get a job. The job market may not be what it was in the past but there's always a supply and demand when it comes to medical imaging. As the reliance on medical imaging only continues to grow with the increase in number of CT and MRI scanners, the job market for radiologists will always be open. As someone who is only looking for a job in one city (one that is super competitive I might add), I have been surprised at the number of listings as well as the number of responses as a fellow in only month 3 of fellowship. In addition, I have only just begun my job search (literally 2 weeks ago).

6. Radiology is boring. I may be biased but I find radiology incredibly interesting. We see different pathologies across specialties on a daily basis. We often get to make the diagnosis and provide a differential. We are not involved in the treatment but for me at least, coming up with the diagnosis is the most satisfying part of my job as a physician. In addition, it is a field that is constantly changing as technology evolves. Imaging utilization only continues to grow and different applications of imaging for both diagnosis and treatment are constantly being researched and incorporated into our specialty.

7. Women should stay away from radiology because it will fry our ovaries. I was pregnant my first year of residency. I have a perfectly normal, adorable daughter. Yes, to be completely honest, radiation can affect a woman's reproductive capabilities but you would need direct radiation to the pelvic area and the amount of radiation would have to in the amount that is used for radiation therapy in oncology treatment. Therapeutic doses are often 1000X more than diagnostic doses (even a CT). Furthermore, as a radiologist, we are shielded from significant radiation doses with the use of radiation equipment and radiation protection practice shields (lead, lead glasses).

8. Radiology as a profession is useless because physicians can interpret their own films. Physicians across all specialties order medical imaging and it should be their responsibility to look at the images they order. However, a formal interpretation by someone who trained in this field for 6 years is completely different. There are many times that the ordering physician has more clinical information that helps in the interpretation of the study. However, when it comes to interpreting the study as a whole that is what we are trained to do--we look to see if its an adequate from a technical point (are there any artifacts on the study? is there too much patient motion?), we look at the entire study (for example, CT abdomen/pelvis is ordered for belly pain and on the few slices of the lung bases, we find a pulmonary emboli), we decide on how to make image quality better (do we need to increase the field of view? what should the slice thickness of the images be?) and lastly, we often decide if the correct study is ordered for the right indication while minimizing radiation dose to the patient (does the study need to be done with contrast? can we do an MRI rather than a CT in a pediatric patient? what study should we order in pregnant patient?)

9. We make too much money for what we do. I can't speak for all specialties except my own but I find it unsettling when I hear this about radiologists. We put in our time with our 6 years of training. We take our boards. We have written reports that cannot be disputed--if we miss something, it is evident that we missed something. Just like any other specialty, we are learning a valuable skill set that helps our colleagues and patients. 

10. We are not real doctors. This one applies more to the general public. We are not the technologists. If I got a dollar for every time somebody asks what I do for a living and I say I'm a radiologist and I get the response "oh yah, I met a radiologist last week when getting my "insert imaging modality" done," I would be incredibly wealthy. However, for someone interested in radiology, the prevalence of this myth one is something to be aware of. I always discuss with my husband who often gets cookies/cupcakes sent home from his patients that as a radiologist you have to be okay with sometimes not getting the direct satisfaction of "saving a life." It's not always "saving a life," but often times we do make the diagnosis but we're not the ones who relay the good news (or bad news) to the patients. I am okay with that. People choose to go into medicine for different reasons and some thrive off the direct acknowledgement from their patients. For me, as a radiologist, the internal satisfaction that I am helping my patients is enough.

Lastly, good luck everyone in their residency applications regardless of specialty!

X-ray Vision