Monday, August 21, 2017

clocking

I have never been one to track my periods, but then life happened and now I am tracking them religiously.

I think back to when it all began. I was one of the last of my friends to get my period. Even though my mother had prepared me with books and talks, I still thought death was imminent when it started. So once they occurred regularly, I just went with it. No charting. No tracking.

Fast forward to my mid-twenties as a medical student. My husband and I decided to have a child before starting residency because it seemed like a good plan. Thankfully Little Zo established himself promptly after discontinuing my IUD. 3 weeks after. I had little knowledge of how truly a blessing that was.

And then life happened. The stories of loss and infertility began to trickle in. A cousin whose first child was conceived in our 20s using in vitro fertilization and who is still paying bills for it; she has been trying for years for baby #2. The friend and aunt who have both suffered multiple miscarriages. The friend who experienced a molar pregnancy and had to consider radiation therapy. The best friends who suffered a stillbirth that I wrote about here: http://www.mothersinmedicine.com/2013/07/life-loss-and-celebrations-of-love.html

Once settled into attendingdom, O and I decided to try again in order to give Zo that sibling he sometimes mentioned. I wrote in my post on December 29, 2016 entitled “(all is not) lost” about our miscarriage (http://www.mothersinmedicine.com/2016/12/all-is-not-lost.html). It was devastating.

And now, without even realizing it, I have begun tracking my cycles. 3 after the IUD was removed and then we were pregnant with number 2. And then the miscarriage.

My D&C surgery was in January 2017. And every month thereafter I prayed my cycle would return. Was that pinch the beginnings of my cycle? Was that the beginning of ovulation. 3 months later, my cycle returned. And each month that went by we still weren’t pregnant. And then. Last menstrual period May 17, 2017. We are overwhelmingly happy, frightened, joyful, petrified, and elated. Big brother Zo is happy. Thus begins a new clocking of days, weeks, and trimesters. Second trimester begins this week. So thankful.

Sunday, August 13, 2017

Street Cred with a Belly

Hello everyone - I joined this blog so hopefully I would remember to take a moment to reflect on my experiences and have the chance to learn and share from you all, so I wanted to share some reflections from my last couple months.

I've always joked with people that I planned on starting a family as a family medicine resident to give me a little more street cred. I am one of those people that still gets carded walking into 18+ establishments - and hopefully someday I will be grateful for this, but at times it's hard to take advice seriously from your teenage-appearing doctor. The most common look I get when telling parents they need to wake up their baby more often because they are not gaining enough weight is the one-eyebrow-raised "mmhmm. Get back to me when you've had kids" look. So I thought on some level, baby = credibility.

I am enjoying being pregnant and seeing patients much more than I thought I would. I'm 31 weeks along now with a very obvious belly. One parent recently pointed at my belly in the office and told her 2 year old "See, she's having a baby too!". I am having so so so much fun seeing my OB patients in the office and commenting on our bellies at the same time. I feel like my advice is taken a little more seriously ("I know it's hard, but..."), but it's more so I am developing wonderful relationships with my patients. I have one patient that is due within a week of me - so we are hoping she goes first so I can still deliver her before having my own. We are delivering at the same hospital, so chances are, we'll be right down the hall from one another if that plan doesn't work out.

Something else that has been surprisingly enjoyable is the change in my interactions with patients in the hospital. Especially my lovely little old ladies. My rounds have become much less efficient as my patients are starting to ask me more about my life as I try to ask about theirs - but again, so much more enjoyable. It reminds me why I like medicine and connecting with people.

My favorite patient encounter this week was with one of my stroke patients in the hospital. She was recovering well from her stroke physically, but she continued to be unable to speak and express her thoughts. I was going in the room with one of my other senior residents to try and assess how much she was able to understand us. While the other resident was talking to the husband, my patient looked at me, looked down at my belly, looked up with a confused look at my face, looked at my belly again, and looked up at my face and smiled. I thought to myself "Ma'am, you know exactly what is going on here". She just left to a rehab facility and I hope she's doing well.

Thanks for letting me share with you all :) I am just eternally grateful for this experience right now. If you have any stories from times you were glad you were a mom or expecting while you're a doctor I would love to hear more!

Saturday, August 12, 2017

Charlottesville

I've been watching the events unfold in Charlottesville, VA, over the past two days. I was already sad; now I am scared and angry as well. I wrote about it on Medium.
None of us is safe. Hate touches us all. Hate threatens us all. If you are white and your first thought is “that’s not me,” then you are not listening. You are not listening to my voice. You are not listening to the voices of people of color. They are telling you we are being murdered. We are being systematically eliminated. We can’t breathe. If it’s not you, then you must work to stop it. We all must work to stop it.
We must. Our children lives depend on it. Our lives depend on it.

Friday, August 11, 2017

(Helicopter) Doctor Moms

As my toddler becomes more and more active, I've been grappling with an internal conflict: how do I balance my desire to let her experience life and take chances within the reality of my risk-averse, medical background? The other day, my mother almost had a stroke in the park, watching my 20 month old girl teeter along on the edge of a three foot tall retaining wall while she laughed with glee at her cousins. Below was grass on one side and a stone tile on the other. "Get her down from there!" she cried. I hadn't thought anything of it: if she had fallen on the grass side of the wall, she would have been fine. She would have learned a lesson on how to place her feet to balance. If she had fallen on the tile side, things might have been fine... or they might have resulted in a broken ankle, or a broken head. Flashes of my baby intubated with a head injury in the ICU swirl through my head, and I have to slap myself to break loose.

So much potential badness and goodness in this picture

I don't want to be one of those helicopter parents. I want my child to learn problem solving, to take chances and learn consequences, and to feel the exhiliration of meeting physical challenges. And yet, as an anesthesiologist, I've seen the worst. I've seen the pediatric traumas and the burn unit cases. I've heard the PICU stories ("How did this happen?"), and I'll admit that I absorb these details differently now that I'm a mother. The information is clouded by a background wonder of what I would do if I were in the parents' situation. Sometimes I see my own child's face in that hospital bed or on the OR table.

As a teenager, I had some friends whose fathers were policemen. They always had lots of restrictions, and because their dads had similarly clouded lenses through which they saw everything, I now understand why. But overbearing parenting has been associated with what Jessica Lahey, author of The Gift of Failure, describes as "emotionally, intellectually, and socially handicapped children." How do we as parents allow our children to grow up with freedom, autonomy, and challenge while still appropriately protecting them from physical harm? If anyone has some good insights on this, I'd love to hear them!

Tuesday, August 8, 2017

MiM Mail: Choosing between nursing school and medical school

Hi,

I came across your blog many times while looking for answers about being in medicine. A little bit about myself: have a BA in Biology and in History, an EMT license, and I work as a nanny to small children. Long story short, my mom died when I was 16 and she wanted me to be a doctor rather than a nurse in order to support myself better. Since this was the only path in medicine we had ever talked about, I now feel like I am betraying her by thinking about nursing. I also want to be a full time stay at home mom (in the far future) which only adds to my dilemma.

In terms of being a mom: I know that it is a loooong ways off, but I am a planner. I have run a household when I was 16 and 17, and I am a nanny to several families. One of these families both the mom and dad are doctors and their kids see the nanny more than their parents. I know I don't want that for my future family. I also do not have a good support system with people who could help take care of kids.

I know for a fact that I want to be somewhere in Emergency Medicine whether it be an NP on an ambulance, a RN in the ER, an ER doctor, or a trauma surgeon. I started thinking about nursing school while becoming an EMT because of the amount of patient contact nurses have in ER. I also know that I'm great with taking care of patients as tech.

BUT, I have been struggling with the idea of nursing for over a year now. I want the higher education of being a doctor and understanding the full picture of diseases. I want to be able to practice good medicine since my family has had so many doctors malpractice. I want to be able to be there for my patients like I imagine you all are. I was accepted to a medical school and I declined because I was engaged at the time.

Things I am struggling with:
1. Patient contact in the ER (I love how nurses are more hands on)
2. Education level (I have come across all types in both fields and most nurses and doctors encourage medical school, but I want to spend more hands on time with patients which I know will not happen in the ER)
3. I want to be able to help restructure programs and protocols to help improve patient care
4. Time to complete both (It is very likely that I will not be able to have children starting around 29/ 30 and I am almost 22. This makes me concerned about residency programs and being held back a year)
5. I've always dreamed about being a doctor and a stay at home mom (reality is hitting that these do not always go hand in hand)
6. I'm struggling to complete nursing school apps (I could get through with little debt in comparison to medical school)
7. Wondering about working part time as an ER doctor vs ER nurse

So, I am looking for your opinions about medical school vs nursing school. It's been hard to find someone who can give me answers when one of their solutions to one part will not work for me. I'm hoping that maybe as doctors and as moms you might see something different, or maybe offer some clarity on the medical school/ residency process. Thank you for taking the time to read an to think, I really truly appreciate it.

Thank you,
Kelly

Thursday, August 3, 2017

What is the longest you have been away from your kids?

I posted this question on my local mom's Facebook page, and answers were either never, or 3-5 days. The exception being one mom who left for 2 months to do field research. She describes the experience as horrible. So basically I didn't get the external validation I was looking for. I am about to start medical school and am thinking ahead to away rotations, as well as being heavily involved in our large Global Health program, which requires 4-6 weeks away two separate times.

So what about you mamas? How long have you been away? Was it for work, school, pleasure? How did you manage? How did you feel about it? Would you do it again?

Monday, July 31, 2017

MiM Mail: Residency applications and motherhood

Dear Mothers in Medicine,

I've been following your blog for a couple of years now, and every single post has worked for me as an inspiration to stay strong and fight for what I love, medicine. But today, I have found myself in a confusing position and I really need advice on a special subject, residency application and motherhood. I'm currently an MS4, yayy!! And as application day approaches, I have been working on my personal statement however, I'm encountering that one of my biggest assets (or so I feel) is being a mother. I have been advice by all my friends at medschool to not even mention my family, husband or 2 daughters (2yrs and 5 months). According to most people having a family will make me a less reliable resident than someone without strings attached. However, this is my story:

I married after college a few months before beginning medical school, my husband and I had been accepted to the same school, and things sounded great. During the first year we adapted to the new environment, developed our studying skills and set our expectations for matching one day.

Fast forward 1 year, and baby #1 came along. She was born during our 2nd year. We managed to fix our schedules for studying around the clock and created routines that allowed us to keep up with classes/exams while taking turns to care for our daughter. No LOA requested/no gaps, we were lucky enough that our baby#1 was born right before one break so we had 2 weeks off to adapt to our new family, and organize. Somehow, we survived and made it worked. Now, let's fast forward one more year and baby#2 came along (we wanted our daughter to have company as our families live across the country). Once again, we worked our way around it. I was able to get 1 week off during one of my rotations and resume the following monday. The attending was very understanding and seem surprised to see that I had decided it to keep going and again no LOA, no excuses given.

Today when I look back, I see that everything that I have done until this day has shaped me to who I am at this point. My desire to pursue medicine, and my determination to continue has remained strong while building the family that I always dreamt of. I always thought of medicine as a career choice not a life changer. As a mother, I feel that I learnt to be more organized and time efficient, I proved myself to be dedicated and goal oriented. So far we both remained on top of our class and have shown the same commitment since day one (I say we because this took teamwork). I took my step 1 and Step 2 CK/CS while breastfeeding/pumping because I wanted to continue to care for my daughters while working really hard to accomplish my goals. I wasn't willing to stay behind. Being a mother helped me connect with patients at more than one level, becoming very understanding of their concerns. I will applying to pediatrics because not only did I mentioned it on my personal statement when I applied to medical school as I always had a passion for peds but during these 4 yrs I realized that I'm drawn toward the field naturally. So I wonder, how can I write a "personal" statement of who I really am and why if I cannot mentioned how I became me and why I think I can be a good asset? I feel that a good physician should be able to show balance and commitment while remaining human and empathetic. Us moms, do this every day at home and on the field. Some people even believe in not even mention it during interviews but to be honest I am proud of being one and hope to become a great physician one day. Please any help or guidance. I am really confused right now.

Thanks in advance for all your help.

An MS4 hoping for the best!!

Friday, July 28, 2017

End of training!

Hello Mothers in Medicine readers,

I am Geraldine Chang. I go by Geri. I have been X-ray vision for a couple years now. Thank you for reading about my struggles of balancing motherhood, long distance marriage and residency and then fellowship. It has been hard for someone like myself who is an open book to be anonymous. However, I was always cautious during training to be so open about my thoughts and opinions.

Anyways, that ship has sailed! I officially graduated from my breast imaging fellowship on June 30th, 2017. I am currently very much enjoying unemployment, which is coming to an end. I did my residency and fellowship in San Diego and now I will be starting a private practice job in Los Angeles. After two years of being apart, my family is now all under the same roof! It has been absolutely wonderful.

But now reality is sinking in. I am about to start my FIRST attending job, which begins next Monday and I am hot mess of emotions ranging from fear to excitement. I hope to be honest and open about my endeavors as a first time attending, expanding my family in the near future and continuing this balancing act all of us workings mom do!

I had it in my head that a lot of the problems during residency and fellowship as a mom would magically disappear when I became an attending! Silly right? But I needed some of that ignorant bliss to get me through all the training but as I was ending my fellowship, I realized there is no magical solution to balancing motherhood and a career. You just have to do what's right for you.

My mom has been pretty much my only source of child care the first two years of little C's life. I am forever grateful but it has been hard on her and also our own relationship. She's no longer an option. After being with little C alone for 2 years in San Diego while big C was doing his fellowship in New Haven for 1 year and another year as an attending in Los Angeles, I grew a lot as a mother and as physician. People asked me how I did it all the time. To be honest, I don't know. When you have to do something, you just do it. And it never ends. But a lot it is just perspective (and a lot of coffee!).

Right now, I am feeling grateful for this new job. I am grateful for the flexible schedule, the obvious increase in pay and mostly, I am grateful that I get a provide my daughter with an example on how you really can do it all. Do you remember me? I wrote a guest blog on this very website.  Here it is--http://www.mothersinmedicine.com/2013/07/guest-post-hard-decision.html

I wish I could give that girl a hug. She really needed one. I still can't read that post without crying because the overwhelming guilt I felt comes back and I feel it to the very core.

But now I know, it all works out. I tell myself this as I am getting ready for a whole new set of growing pains, which includes new job, new school and nanny for little C and overall, a new routine and with that I know will come with some degree of mom guilt.

Thanks for being my support. Thanks for listening! Now that I am no longer X-ray Vision, you can also read my personal blog to little C at www.doctormomwifealloftheabove.blogspot.com or follow me on instagram at gerichangmd.

Thursday, July 20, 2017

Great article on STAT on female leadership and health care reform.

Genmedmom here. I simply to call attention to a wonderful article on STAT written by a kick-ass healthcare administrator/ CEO and mother of SIX children (yes, six, and TEN grandchildren, per her profile) Annette Walker. It's titled More female leadership: a different kind of health care reform and it's spot-on.

She points out that "women hold only 26 percent of hospital CEO positions and 21 percent of executive positions at Fortune 500 health care companies even though they make up 78 percent of the health care work force". This despite the fact that "Study after study has demonstrated that organizations with gender-balanced leadership are more successful than their homogenous counterparts."

The best part of this short piece is her emphasis on solutions. What she has accomplished in her own hospital system can surely be adopted in others. She lists:
  • Flexible work arrangements
  • Training opportunities for women to build leadership skills
  • Increased visibility of female role models
  • Connecting junior employees with female senior-level mentors
  • Transparent advancement opportunities and clearly charted pathways to leadership
  • Shining a light on the challenges of balancing family and work needs
  • Support for community programs that promote opportunities for women in our service areas
  • Emphasizing STEM and academic programs for women
I love what she's saying and admire what she's accomplished. I mean, all this and SIX kids, I just can't even imagine. Two kids has almost put me over the edge. Holy cow.

This blog is certainly helping to "shine a light on the challenges of balancing family and work needs" of doctor-moms, so let's acknowledge what MiM brings to the battle! We can also take a look at this list and think of what may be applicable in our own practices, hospitals, and medical schools.

Ladies, let's take some inspiration and motivation from Annette Walker, impressive mama and hospital CEO.

Monday, July 17, 2017

The Devil You Know - A Book Review

I get really annoyed by those people who declare, "I only read non-fiction." And it's ok, if that's you, but don't say it snootily at a party when someone asks you if you've ever read this great fiction book. That's left me speechless and a bit shameful on more than one occasion - the person acts like fiction is non-fiction's red-headed bastard stepchild. And really, if I could go back in time - let's do that right now - I'd tell that person off. Fiction, I'll argue, is way more difficult to pull of than non-fiction. And I'll be damned if you can draw a straight line between the two. Fiction authors often weave autobiography into their own work, but instead of just spitting out what already happened they birth a new child. And that's pretty impressive, in my opinion.

I met Fizzy on Mothers in Medicine years ago when I first started. We became e-mail friends, she supported me through my divorce, I learned a little about her life. She is a very private person. I've met her for dinner once and I still don't know her last name. I respect that, and it comes with mystery and intrigue. We don't e-mail as regularly as we used to, but when she asked for me to read her new book a few months back and let her know what I think I felt like I had received an e-mail from Madonna (that's a nod to the book, by the way). I read it in one afternoon. Well, it bled into the evening a bit.

I read the first book, The Devil Wears Scrubs, years ago. I loved it, and talked about that here. What I loved about that book was how it captured the angst of medical school and training. What I love about this more is it captures the angst of mothering and working as an attending. It is a stand alone book - you don't have to have read the first one, but it was fun for me to reminisce about old characters as they were brought up again throughout the book.

Warning: This book will make you laugh out loud. A lot. Fizzy has always had a great sense of humor and in The Devil You Know she doles it out constantly. There was this one part about glitter - I almost put in a quote but I don't want to ruin it for you - where I was laughing so hard I had to put the book down. She perfectly combines the mayhem of being a doctor and a mother and a spouse - and doing it very imperfectly perfect. If you are taking yourself too seriously this is the book to pick up. I read it again to make this review better and it was a bunch of fun the second time around. One of the best things about it for me was I got a great big glimpse into my very private friend's - one whose blog - A Cartoon Guide to Becoming a Doctor - I've followed for years - life. No one can write a book like this without experience.

I could go on and on about the hilarious patient interactions and bumbling cast of characters at the VA (one of my favorite places on Earth where I trained) but Fizzy herself would stop me - I tend to get long-winded. JUST GO GET THIS BOOK ALREADY: HERE. You won't regret it!!


Side note to Fizzy - who ribbed me years back for never having read a book on a Kindle etc. - I have now read one book on my computer and phone exactly twice - yours.

Tuesday, July 11, 2017

Bridging the Wellness Gap

I have to give a shout out to my hospital (University of Utah*) and my department (Anesthesiology). We are trying. In the age when burnout is rampant and physicians are frequently leaving clinical medicine, we are working to foster camaraderie and resilience. A few examples:

The women in my department recently held an ad hoc Ladies' Lunch. We do this every once in a while, approximately once a year, but we should work on making it more frequent. It's merely a casual potluck lunch held at a faculty member's house for all the female anesthesia residents and attendings, but for me it represents more. Because I work part time in such a large group, I can go weeks to months without seeing some of the other faculty. Anesthesiologists practice their specialty alone, so in order to process work-related issues we have to consciously make an effort to seek out those connections. Our blue scrubs and hats were replaced with sundresses and sandals, and the conversation turned from patients to children, schools, and summer vacation plans. Resident MDs who have yet to venture into practice ate lunch alongside veteran tenured professors. Many of us are moms, with children ranging from 8 weeks to 19 years old. I learned some useful school information from a few of my colleagues with grade school-age girls. It was also interesting to talk to a couple of the ladies who work exclusively in the pain clinic, sharing stories about work environment and frustrations with the medical system. Two babies even made appearances: one wide-eyed, active 11 month old and one brand new infant attached to her mother's breast at the buffet table!

We started an intra-department monthly wellness newsletter (managed by my colleague Dr. Jennifer DeCou), which not only includes interesting personal tidbits about faculty members but also links and info for wellness resources. In addition, Jen has spearheaded a plan for immediate support, in the forms of work relief and counseling, when any anesthesiology practitioner experiences a sentinel event or a bad outcome in the OR.

Our hospital just opened a Resiliency Center on the medical school campus. It provides a space and some resources for relaxation, but the main advantage of this addition is a dedicated space where for on site, free and confidential counseling services. I have personally utilized the services of the third party counseling group on two occasions during my employment already: once when I experienced a health scare during my residency, and again when I underwent infertility treatment. It was invaluable to me, and now it will be even easier for employees to access the benefit since it will be in such close proximity to our workplace.

The piece de resistance... our hospital recently opened a faculty lounge that feels like an airline sky club. Attending physicians from all specialties are invited to use it for eating, changing, working, conferencing, meeting, sleeping... it has all of those features. Not to mention two fully automatic coffee drink dispensers! We have never had a physicians' only lounge before, and I'm excited to socialize there more with doctors of other specialties.

Where we could do better: childcare. As physicians, our schedules are often unpredictable and out of our own control. I live in fear of the midday call from my daycare that my child is sick on a day that my husband is unavailable to extract her, or the moment I get stuck in the OR with no one to pick her up at the end of the day. Some physician friends work at places where there is on sight, low cost childcare with extended hours, which to me would be the ultimate benefit. Within the past year, my hospital has at least added a backup care resource to their benefit package, but my experience using it so far has not been seamless.

Does your hospital, clinic, or practice group offer any unique services or facilities to enhance your work experience and promote wellness? Share them here so we may all get ideas to bring back to our own places of work!



* The opinions expressed here represent my own experiences and are not those of my hospital or department.

Wednesday, July 5, 2017

Refining

So this is my introduction to you! I’m excited to be a regular contributor to Mothers in Medicine. I practice family medicine by day and wrangle my brood of three small children by night. My oldest just finished kindergarten and my youngest just turned one. I’m approaching my ninth year in a busy primary care practice in the Pacific Northwest. I enjoy the privilege and challenge of caring for a variety of patients, from newborns to nonagenarians. I used to practice obstetrics as well, but haven’t since having my own babies. I miss it sometimes.

After finishing residency, I studied tropical medicine in London and have worked at a rural teaching hospital in Kenya. My teacher husband and I dream of living and working abroad with our young family; maybe when the majority of them are out of diapers.

I began writing in earnest after I had my first child in 2011. I did write throughout medical training but it took the refining aspects of motherhood to get me to take my writing seriously. Nothing like even less time and an unveiling of your faults for some forced self-introspection! I’m curious if any of you have found motherhood to be similarly clarifying? I’ve studied narrative medicine and bioethics and have taught narrative medicine workshops. Particular interests include medical ethics, global health, motherhood as vocation and the intersection of religion and science. I blog regularly on these topics, among others, and I’m currently working on my first book. I still always cringe a little when I hit “publish” or “send.” I imagine it will always be hard, as a type A introvert, to put myself out there.

My third, and presumably last, baby just turned one and I finally feel like I can breathe again. It feels like a milestone, reaching this point, after having three children in five years, settling into my primary care practice, letting myself take my passion for writing seriously and expand into that vocation.

My life has been disrupted many times in the past year with unexpected challenges and writing and community have pulled me through. I think much in medicine and in motherhood is refining: the pressures of medical school and residency, the intensity of caring for babies and children who need so much.

I’m excited to join you all in this journey; to learn from your wisdom and laugh alongside you. If medicine and motherhood have taught me one thing, it’s that we all need each other desperately - for kindness, for encouragement, for understanding. These are the things to cling to and to provide for each other in this world. Thanks so much for having me.

Monday, July 3, 2017

Time To Move On



Hi, I’m new here.  And very honored to be here, at that.  I’m a pathologist, in private practice for > 5 years (settling in to the flatter portion at the top of the exponential career curve of knowledge/abject terror), but < 10 years (I suspect, the point on that curve at which cynicism overrides all other basal functions and drives one towards a retirement countdown sticker chart).

I’m in my second post-training big-girl-pants job, and I’ve been here for a little over 8 years.  I briefly tangled with a super-crap job, lasting only six months right out of training, working for a very bad man rocking various personality disorders.....but that will be another story for another day.  This current job is where I became an adult.  And this job is where I damn near had my love for pathology drained of my brain completely.  But it’s time to move on, and I’m doing just that.

Over a period of years, I had somehow found myself struggling to get through the work day, doing twice as much work as is safe to do, getting paid a quarter of the money being made off of my back.  I had become everything to everyone in my office and to the clinicians in the hospital, and nothing to myself professionally. I hated every minute of it.  And my marriage was suffering for the long hours, which I finally figured out after hearing myself in every conversation trying to justify my absences. It just didn't sound authentic to me. Working 60+ hours a week as a pathologist is not particularly normal. But it took a while for me to figure this out -- Stockholm syndrome is real, ya'll. And then, nearly exactly two years ago I had a gorgeous baby girl, induced at 36+1 weeks for oligohydramnios, weighing in at a whopping 4 lbs 15 oz.  And my placenta was just as small as that tiny girl, 5th percentile.  Everything was "fine" until it wasn't.  I've since learned that many of the births to female docs in similar situations to myself are premature for various reasons, commonly for oligo……………can’t help but think there is a link there. 

I’ve worked with some wonderful people over the years while doing this job.  Most of the ones who have stayed for longer than a year are the type that persevere long past the expiration date, and they just keep on going.  Each seems to have his or her own reason for doing so:  'finish what you start', 'I cannot be defeated', 'everyone will like me eventually', 'it’s not really that bad', 'I deserve this pain', 'it is too hard to change'.  What is my reason?  I’ve already made too many mistakes.  This can’t be another one.  I can make this work.  My family is depending on me.

Life is too short to stay in a job that is soul-crushing.  No job is perfect certainly, but no job should harm your psychic core or fizzle your spark.  If you don’t recognize the person that you were, that idealistic nerdling resident, marveling at those exquisite enterocytes mingling with those gorgeous goblet cells, and you can’t find her deep down in there somewhere………..it’s time to make a change. And preferably before that gal has packed up her shit and moved to the outer recesses of the universe, never to be seen or heard from again.  Mistakes will always be made, some big and some small, but they can always be corrected.  Be the change, as they say (whoever they may be).  You always have the power to make things better.  I have become a path beast during my time here, and now I’m doing my best not to become a pathological beast.  Put yourself into the situation that you want to be in, whatever that may be.  It could take awhile, sometimes may even take eight years and some major life changes.  Remove yourself from the people and entities who take everything from you and give nothing back in return.  I’m doing just that in short order.  Even though it’s a move to a more backward state than the one in which I currently reside, but that’s yet another story for another day………

Take care of yourself first, the rest will follow.

Progress and peace to my fellow burnout warriors :0)
TheUnluckyPath

Monday, June 26, 2017

Control Issues


Hello everyone! I am going by Kicks, and I am 4 days away from finishing up my intern year in family medicine residency! We're currently pregnant with our first and can't wait to absorb all of this community's wisdom and advice. :)

Today was a rough day.

It started out okay. I'm on inpatient wards now, and I knew most of my patients going into the day. I had a very reasonable goal of being done by 3 to make my 3:45 OB appt with plenty of time to spare.

I enjoyed my AM visits with my patients, however I was late to group table rounds due to a few chatty cathys - one who had plenty of demands before going home tomorrow and one long conversation regarding an abusive situation. Rounds went until 1, however I knew I would still have time to do notes and do my last minute tasks before 3. And, being pregnant, obviously deserved a quick lunch break for nachos in the cafeteria. I have been trying to be a good role model for well being for the medical students on the service, and try to make an example of making time for lunch (although sometimes when they're not there, I try to sneak by with a Naked juice and cottage cheese break occasionally. Baby-to-Be loves the Naked juices).

After lunch, one of the medical students went with me to discuss MRI findings with one of our patients. We both were stuck in front of our loading EMR for awhile, and I made it a point to tell her that sometimes watching the EMR loading bar and being stuck in one place not being productive for a few minutes was a reminder for me to take a deep breath and remind myself I am not always in control. (Again, when I don't have a witness I've also been known to lightly slap the computer monitor). The MRI showed a likely tumor, so the discussion took awhile. I also had to stop downstairs and discuss the abusive situation from above with one of our social workers.

So clearly I am already running late. However, I hammered through my notes and was able to escape by 3:30 - so if all went well I would make it exactly on time to my 3:45 appointment 15 minutes away. Very doable.

I was not even one block away from the hospital when I got stuck. I have no idea why this van was stopped in the middle of the road, but it was surrounded by other cars who couldn't get around it. I waited at my light a few rounds before realizing this van wasn't moving one inch. I tried to go around the block - along with the rest of the world. Some random construction also popped up. Within half an hour, I had not made it 4 blocks away from the hospital.

I called the OB office in almost tears from my frustration. I felt terrible - the other intern was covering for me leaving early and I couldn't even make it to my stupid appointment. The scheduler on the line sounded slightly alarmed at how upset I was, and reassured me it would be okay and I could always call back in the morning to reschedule.

I felt awful. I don't think I have ever missed a doctor's appointment before. Where did I go wrong? Should I have taken a shorter nacho break to leave earlier? Should I have tried to write a note or two while the other residents presented during table rounds? Should I have delegated more of my afternoon tasks? The guilt piled on when I realized this was still pre-baby life. I had a mental image of Baby-to-Be sitting alone outside of the deserted daycare waiting for me, the long lost parent not yet able to make it home from work. And it got worse when I got home - and saw the laundry, dinner needing to be cooked, messy table and counter tops, Dog in sore need of a walk, and again realized - this is pre-baby life during residency and I am already exhausted. I cried into Husband's hug, and he promptly suggested leftovers for dinner and a nap for me.

I can say now I am a more functional person tonight s/p nap. And the dog did get a walk, but everything else is still dirty and that's okay. And it's okay to miss an appointment here or there - because one has to assume one can travel 3 blocks in a 30 minute time span on a usual day. Crap happens, and - as I was hypocritically telling the medical student just hours earlier - I am going to try and take more of those forced unproductive moments (like sitting in traffic) to take a deep breath, and carry on.

4 days left of intern year, guys. Just 4 more days.

Sunday, June 25, 2017

Moving with Boxes: The Milk Update

My Monkey (3) wants to go home. One night this week, he started crying, sobbing, about milk. He is a bit speech delayed, so it is hard to understand him sometimes, but while we can usually figure it out; this time, we had no clue.
Monkey(5 AM): "Milk with cow! More milk!"
Me: You want another bottle?
Monkey: NO!! Milk with cow!
Me: What?
Monkey: Cow! Milk with the cow!


After 20 minutes of taking everything out of the fridge, his suitcase, and the pantry, I finally realized he was talking about the brand of milk we used to buy. The milk I bought had the wrong logo and all he wanted was a different brand of milk. So, the next day, we went to super specialty fancy store to get the milk he wanted. (Because here, in NEW CITY, they don't stock it in the general local grocery store).

Like the milk, we are slowly figuring things out. We are still in mattresses on the floor, because our truck is somewhere in the middle of America. The old washer that came with the house made rust stains on all our clothing. We ate 5 days of pizza/hot dogs and fast food takeout. But it's been a LOT more fun and a better adventure that I was anticipating.

I know my post last week was super intense. With the whirlwind of the first week in a new home and new city behind me, I can happily say this one will be a lot lighter!

The past week, our life has been a series of lists. To do lists, errands, stuff we need for the house, day camp supplies, etc.

So, here is my update list:

1)  Your village can be online. The minute we got on the plane, my sister, brother-in-law, and other siblings got together virtually to order a whole box of essentials on Amazon Prime Now to be delivered to our new home. That first night, after straggling off of the airplane/Uber journey with 2 very very overactive children and 1 anxious dog, I felt such a surge of relief, joy, and gratitude when I noticed the familiar Amazon logo. We already had a stock of tissues, toilet paper, dog food, dog bowls, Cheerios, hand soap, and Cheerios waiting at our doorstep. It was as if my entire family was there, hugging us, welcoming us and cheering us on. 

2) Make new friends but keep the old. My mom's old childhood friend, who I knew well as a child, but have had little interaction with in the past >20 years, lives in our new city. My mom reached out to her and as she is such a gracious woman, she has been like a second grandma to us the past week- bringing us dinner, allowing us to swim in her pool, and giving me lists of handymen, gardening advice, and other helpful pro-tips about our new town. I miss my mom so intensely, but having someone here is making that void a little less raw.

3) Be open-minded. My husband has a sister in our new city (the one saving grace for my husband). With medical school obligations for most of my marriage, I have not had a chance to really form a super close friendship with her (we see her maybe 1x/year). She has her own family and obligations, and I was tentative about asking too much of her. But she brought us dinner our first night, and has been SO above and beyond helpful, kind, welcoming, and supportive. I am looking forward to getting closer to her and actually forming a proper relationship.

So, even though all 4 of us have all been sharing 2 towels for a week because our truck is MIA and I refuse to buy stuff we already own, I think we can call week 1 a success! Orientation starts tomorrow, so hoping the good times continue!

- Boxes

Thursday, June 22, 2017

Hostage

Tonight there will be no ransom paid, despite the long list of demands:

wash the dishes
clean the kitchen
wipe down the highchair
finish charting
return emails
analyze research results
research preschools
order Spiderman pj's
check yoga schedule - missed it tonight, maybe tomorrow
pay bills
fold laundry
feel guilty for not doing more


Tonight, the hostage will be released after being locked away too long. Into open arms it will stumble, what was once so comforting feeling foreign, unsure how to proceed. It is time to disregard the ransom, knowing such a sum will never truly be paid: best just to let it go, start anew.

Tonight there will be no ransom. Only the freeing of that long-awaited, so often yearned for, prisoner:

Sleep.

Moving with Boxes

Hi! I am so excited to join this community. I have been following since applying to medical school 6 years ago and now, med school and 2 kids later, am honored to be able to share with this community more regularly.

I am usually an upbeat, sunny side up, West Coast girl. But I would like to introduce myself with a post that bares my soul and reflects a more raw version of myself. Below is what I wrote 3 days ago, the night before getting on a plane with my husband, kids, and dog, to fly across the country to start EM residency. With the chaos of moving I didn't have a chance to share until today. I'll hopefully post a more positive update later next week!

I'm flooded. And overhwlemed. and the dam that has been holding my emotions at bay has broken and every thought, fear, feelings of guilt, absolute fear, and sense of desperation keeps washing over me, unrelenting, like a wave, as I fight the current in the tumult of emotions  that keeps pounding relentlessly. 

let me backtrack. 

when I fell in love with emergency medicine the beginning of 3rd year, I knew that was the only field of medicine for me. the pace, the variety, the sense of camarederie, the fast paced atmosphere. I was hooked. I also knew that getting a residency position in my home town would be a stretch. my step 1 scores were okay, but test day was blunted by braxton hicks contractions and running to the bathroom with my 8.5 month waddling belly and I underperformed all my practice tests by about 10 points. so when eras and interviews started, i knew that moving away from my hometown was a real possibility, if not probability. 

on match day, i told me parents and grandparents and aunts and siblings  (who all live within a 5 mile radius of me and the med school) not to come. i knew i would not get in to the top 10 rated programs in my hometown. i was right, and opening that envelope ensured that my husband, 2 kids, and i would be traveling for an adventure across the county for at least the next 3 years. 

i went into GO mode. i found a house, registered the kids for school, hired a moving company, organized a goodbye party. but we leave tomorrow. and i am now terrified. 

i had my daughter, Chicken, a few months before starting med school and my son, Monkey, after Step 1. My kids go to my parents every day after school and most weekends when i need to study. They play at my grandparents' house on Sundays. My aunts and siblings have driven more carpools and orgsnized playdates and provided last minute babysitting more times than i can count. and now i am leaving the village that helped my little family thrive in med school and we are leaving so so far away where we have none of that.

i am just so scared. so scared that my kids will feel lost and alone. so scared that they wont be able to continue strengthening the amazing relationships they have with their grandparents and great grandparents. so scared that i will ruin or permanently derail my husbands career. so scared that it is all my fault because chose too competitive of a residency and wasnt good enough to get in at home. 

i love my program. i am going to love residency. im just so scared of what i am going to mess up in the process. 

Wednesday, June 14, 2017

Greetings from TXgal

Howdy wonderful MIM community!

I am excited to have joined MIM as a regular contributor this year! I’m TXgal, a name fitting not only because I am from the great state of Texas, but also because I have been trying to escape it for years. One thing or another has kept me here: being close to family, landing an awesome job after graduation, the low cost of living, having babies, and now it’s the ridiculously low medical school tuition when compared to other states. Jealous yet? You don’t have to be, it is freaking hot. But I am starting to accept that this is home, and even loving it!

I am 29, and in 6 months I will be 30. This never bothered me until last month when I looked in the mirror and I saw wrinkles. I won't go into how much grey hair I have. I always thought I would age with grace and acceptance, but right now I am longing to be 25, rocking my pre-baby body. I am also starting medical school in 2 months, which I imagine will only accelerate the aging process. (Especially frown lines). Both of these things have got me in hammer mode. Last 2 months of freedom before starting the rigorous path of medicine, and last two months of freedom in my 20's. I have got to get the best body of my life, meditate, read, write, start my blog, finish projects around the house, learn Spanish, do all the hobbies I won't be able to do once school starts, stop wasting time on Facebook, teach my kids to swim, potty train etc. etc. etc.

But I am also beyond excited to start medical school. I am a non-traditional student with a background in nursing. I landed my dream job right out of nursing school at a Level I trauma ER. The first day of my new job the charge nurse gave me some advice. I didn't listen to her. She said don't date ANYONE here. Not the doctors, not the cops, not the paramedics, or firemen. Especially not the doctors. Perhaps I should have listened. But I fell for a resident, and after a year of dating I got pregnant with my son. Thanks Plan B. What a little darling he is. Into my life he came, and out went all my plans. Like many other premed students, I am a control freak. I like order. I like plans. No, I NEED plans to function. I was going to do a year of travel nursing, and spend a year abroad working for MSF, and then go to medical school, and somewhere far down the road, far, far, FAR down the road I would start a family. I quit my job as a nurse and stayed home with my son while completing my pre-med courses. This was a difficult time for me. It was lonely, and isolating. The entire time my head was spinning with thoughts like "how will I be a good doctor AND a good mom?" "How will I go to med school with a baby?" "When should I go? When he is 2 or 10?" "How will I ever work for MSF?" "Maybe I could just be a stay-at-home mom, or a nurse, or a teacher, or a wildlife photographer, or a stripper." The thoughts literally and metaphorically made me dizzy. (This is when I discovered this LIFE SAVING blog)

I have learned a lot since then. I learned that I am not a stay-at-home mom. I learned to let go of control over my kids. That they are OK, and even thrive at their daycare. They are OK with a sitter, and they are OK at grandma’s. They LOVE grandma. I learned to find balance in school/family life. Yes the load in premed isn't anything like med school, but I learned some tricks. Like don't even attempt to study around the kids unless you want scribbles all over your books. And, don't expect to take a 7 hour timed practice MCAT test and score well with a newborn in lap, so GET A SITTER! Also-DON'T. LAY. DOWN. You WILL fall asleep. Oh, 15 months after my son was born, my daughter came along. Another unplanned little darling.

I am also grateful. I originally got accepted into a program 800 miles away. BD (baby daddy) would have had to stay in our current city for work, and I would be leaving two sets of wonderful grandparents. 2 weeks before our moving van was scheduled to whisk me away with 2 toddlers to start med school alone in a new city, I got an acceptance to a school close to home at an institution known for its (relatively) laid back atmosphere, and relaxed schedule. I am so grateful for this. I am grateful I have so much support from BD, my parents, and BD's family. Grateful to my 26 year old self who continued to complete premed classes despite being so uncertain, who started studying for the MCAT with a 2 weeks old (and eventually got a sitter). Grateful for my kids' teachers, and babysitters that fill their day with joy.

So now as I move closer to med school, I am no longer dizzy with thoughts of uncertainty. I know it'll be crazy, and stressful, and hard. But I know I cannot see myself doing anything else. (Even if sometimes I wish I could). I know at times I will miss my kids, but they are surrounded by friends and family that love and care for them as much as I do. And the obsessing over the wrinkles? I know it’s a phase. They are beautiful just like my grey hairs. Who would really want to be 20 again anyway?

-TXgal


The Shorter version:

TXgal is an about to be 30 year old, nontraditional, incoming MS1 with two toddlers (born 2014 and 2015) and a nontraditional life living with her supportive BD (baby daddy). She has spent the past three years pregnant, or breastfeeding while completing her pre-med classes, and MCAT. After years of uncertainty, she is happy to start medical school knowing there is nothing else she can see herself doing, (well maybe a photographer for NatGeo, but that’ll come later) She is forever newly discovering how she identifies as a mom, individual, almost 30 year old, and soon to be medical student, and looks forward to blogging about the joys, struggle, stress, and victories in finding this balance. She also has a gazillion hobbies, and likes that include: gardening, yoga, reading, coffee, rock climbing, running, traveling, hiking, visiting National Parks, photography, healthy eating, Latin dancing, planning her life, re-planning her life after plans fail, family vacations, studying, and watching NatGeo with toddlers, cheering for the prey when they get away.

Monday, June 12, 2017

Stay at Home Starchitect

All Spring my husband researched options. He had a great job, and they loved him so much they gave him leave without pay to get extra vacation time with  me and the kids (standard for architects is 2-3 weeks and I get much more than that), but he was tired of working on multimillion dollar housing projects in other cities - jobs that take months to complete. After exploring other job offers, he met with my financial advisor and decided to take a plunge from the corporate world and form an LLC. He would work from home and start his own business. He gave notice at his job a couple of months ago.

The first week he was home it was as if the boil of logistics that was our life, a life I knew no variation of in this marriage or my last, was lanced. He has always pitched in as much as he could, but this was different. Someone to be there to get packages. Let the bug guy in the house. Get one of our kids to the impossible 2:00 in the afternoon orthodontist appointment. Grab the cake for the birthday party. Get the honey we forgot at the grocery store last weekend that left my morning eggs unbalanced and naked. As end of school transitioned to summer, it became even more rewarding. My kids at 14 and 12 are old enough to be alone now, but having an adult at the house to check in with before they walked to the local pool to meet their friends and receive them when they return is a huge bonus. Someone to drive them to a sleepover earlier than 5:00. Someone to eat lunch with them. And we agreed, most importantly, the bonding of their relationship, stepdad to kids, as the kids are reaching an unprecedented age of independence.

He has already turned our guest bedroom into a sleek home office and is starting to craft a business card and do some research. The many contacts he made in the past have already landed him side gigs. And he is happier - getting a long bike ride in every other day. Not having the pressure of 8:30-5:30. That happiness makes our house happier - not that we weren't before, but it's better in a way I could not have imagined. So much so that I suggested he take some time off. Take it slow. We are traveling much in the month of June, so maybe wait to gain traction until July. He is more than amenable.

I don't want him to become the carpooler come Fall - we both want his business to succeed. So I'll put boundaries around his time - maintain an aftercare driver to get the kids from school and to all their activities. But this level of support is nothing short of mind blowing. So I was surprised one night last week when jealousy reared its ugly head. I didn't share my feelings with him at the time, but it was 12-15 hours of why do you get to do this and I don't circling my angry brain and it came off as crankiness and being short one evening. I was jealous he had lunch with the kids. I was jealous of his time during the day to exercise.

Now, to be fair, last week was one of the hardest weeks I've had in a while - call duties, high caseloads every day, terrible work drama, some family drama, and autopsy drama of all things. So I was grinding my teeth getting work done and working very hard to center myself and approach every issue with as much grace and calmness as I could muster. And I think I succeeded, and am happy I sold away my call weekend so I could get in some much needed chill time. But I knew I needed to explore this jealousy thing, so I did one morning at the scope.

He is very different than me. He tends to work better without boundaries around his time. He can adhere to our family schedule, and plug in to work at night when the kids are not with us. Not me. In the past, when I had time off between my first marriage and med school, I quickly lost myself to entropy. I watched Lifetime all day long. I quit exercising. One or two hours on the couch turned into one or two months. So much so that my then husband worried. "I think you always need a job. Please tell me you will always have a job or be in school." To be fair, I didn't have kids back then, and I was in my twenties, but I think he was right about my personality. I need to be responsible to someone or something in order to feel personal reward. Schedules anchor me. My cases, the patients behind them, the frozens, bronch lab, interventional radiology, it's a fuel that keeps me going and performing. Last week was too much, but most weeks aren't filled with all of that. I would not want to be a stay at home pathologist, not only because I don't think that's possible yet but I also need space away from my house to be productive at what I do. The hospital is my sacred space.

So I breathed and apologized the next night for my crankiness and told him about where it came from. He agreed to make space in the evenings for me to work out like we used to together on nights without kids instead of wanting to eat as soon as I get home. And he brought the kids to work one day to eat lunch with me - the kids hadn't done that in a long time and I know we will do it again this summer we all had a blast.

I remember when I was going through my divorce or maybe a new single mom KC won a well deserved prestigious award for starting this blog. In an acceptance speech she was tasked with advice to being a successful mother in medicine. Her first piece of advice was to marry well. I'm proof that if you don't get it right the first time, for whatever reason, it's possible to get it right the second time.