Tuesday, February 21, 2017

MiM Mail: Challenges of being a working parent of school-aged children?

I'm a resident and a mom, with two kids in elementary school. As my kids have gotten older it has gotten a lot easier to "balance" medicine and home life, but I am still quite frustrated with some of the residual things I'm unavailable for. Specifically, it's tough feeling out of the loop regarding school and extracurricular activities, such as having someone else do their homework with them, not being there right after school to hear how their day went and meet their friends, and not getting to observe many extra-curricular activities to determine their quality/worthwhileness. How are you moms of older kids staying involved with those important aspects of their schooling and overall life? When I attend parent-teacher conferences I seem to get positive feedback about how things are going but it's also somewhat generic. I was also wondering in general what some of the challenges of being a working parent of school-aged children and teens are and how you've counteracted those? It seems most of the advice online is for moms of younger kids. Thanks!

Thursday, February 16, 2017


(Warning: serious serious whining and verbal diarrhea ahead, but I will blame it on not getting more than 5 hours of continuous sleep more than twice in the past >11 months. Admittedly, entirely my fault.)

I feel like I’ve maxed out. I want to “cry uncle” to life right now. I am tired. I need a break. Break from work, break from kids, break from the baby, break from my boobs, break from dishes, break from the cycle of daycare-work-evening marathon getting everyone fed/bathed/sleeping-passing out while putting my older daughter to bed and feeling guilty for not being able to get a couple more hours of work done afterwards. Then waking up all night, feeling like a wreck in the morning, and doing it all over again with no end in sight. Break from my husband being so busy too. Break from taking a raincheck on every holiday that comes around (birthdays, Christmas, Valentine’s day, anniversary) because it feels way harder to actually plan something or think about gifts. Break from feeling constantly broke and not being able to get help around the house, babysitting, etc. Break from feeling too tired to have sex. Break from making dinner and planning meals. Break from being the one who plans everything, even if we were to have some sort of vacation. I don’t even want to go on a vacation because that would mean more work. Break from feeling like I never am on top of my lab work or studying. Break from feeling more exhausted and depleted over the weekend and at times longing for Monday morning to arrive. Break from absolutely everything.

I think what I really need is to travel back in time and enjoy a weekend when I was 10 years younger. Because if I went to a hotel overnight and slept for 12 hours, I would think about the kids and miss them. I would feel bad that my husband wasn’t getting rest too, because he needs it just as much as me (well, maybe I do a little more haha) or that we weren’t using the opportunity to reconnect and have some special time together.

I always remind myself that this is all self-imposed. I had unprotected sex. I chose to have kids. I chose medicine. And I wanted both at once. I am a sucker and never stopped nursing my now 11 month old to sleep and have created a monster who wants me every few hours all night, every night. But I am too tired to resist going to him, because the sooner I do, the sooner we are both back to sleep. It’s terrible. This phase of life isn’t easy for anybody. I know some people never can ever even entertain the idea of taking a break because of life and financial circumstances so I should be grateful for the theoretical possibility.

Deep breath. It’s okay. One day at a time.

I think I just need to sleep.

Tuesday, February 14, 2017

I Am Her Doctor, and Her Friend

I have a good friend named Mary.* We met at 15 (she was 14), volunteering at a camp for severely handicapped children. The weekends were called Respite for the full time caregivers. The campers ran the gamut - Cerebral Palsy to Prader-Willi to Down's Syndrome. We both excelled at our task - this was before service hours were a college application box to checklist. We believed that what we were doing would make a difference.

We became fast friends. In spite of our lofty aspirations, we were also teenagers finding ourselves. She was and still is gorgeous, I was drawn to that. She was also lots of fun. I had a hardship driver's license, and we headed offsite one night to buy a Playgirl magazine at a local convenience store. We got back to camp, looked through the pages, and were profoundly disappointed in the staged pics of men in thongs. "Who gets turned on by this?" we wondered. The Playboy's I snuck from under my Dad's bed when I was a tween were much more interesting than this.

Once we double dated in her small town of Salem - she set me up. Let's call them Dusty and Dylan. I was the only licensed driver. I decided to be the sober driver. They were all drinking Purple Passion. She and I had to use the restroom, so we stopped at the local grocery store.

While we were in the bathroom, the boys were up to no good. We climbed back into my 1983 Oldsmobile Toronado convertible.  I stuck the keys in the ignition, and saw blue lights flashing in my rear view mirror. Seems the boys had decided to steal beer from the storeroom without telling us - stashing it in my backseat. We sat in the grocery store high box, surrounded by plexiglass (remember those?) until we were finally told we could go home sometime well after midnight. Thank God, I told Mary. They are honest.

Mary and I are the kind of friends that while staying the course move in and out of our friendship for years at a time. It's our norm - we both have big circles. I will never forget her support after my divorce. She invited me to everything for a year - her parties, her Florida vacation home. It was a respite for me and my kids. She also recommended her storeroom floor designer to be my decorator, who helped me with my home after my divorce. When I was married last fall, her store's event spinoff furnished my beautiful reception at the Clinton Library.

We hadn't caught up much in over a year, so I was surprised when she texted me last week. "I'm having surgery next week. A cyst the size of a grapefruit. I told the surgeon to send it directly to you."

I texted the surgeon immediately. "I've got this, you don't have to do anything. I've called the gross room."

I scoured two pre-ops on her surgery day, before finally finding her. When in the second one, I asked some nurses to help me find her. One challenged me. "Are you family or friend?"  I answered, "I'm her friend." "Well then you need to check in at guest services. All family and friends must go to guest services. Leave pre-op, you will find it around the corner to the left." I felt taken down a notch - my doctor coat meant nothing to her but a challenge to beat down, and since she didn't recognize me she put me in my place. I was so shocked I just did what she said - I have been in pre and post op many times over the years and have never been treated that way. I vowed, in the future, to assert myself more. I'm not only her friend, I'm her doctor. Albeit one behind the sidelines, but important nonetheless. So if I need help finding her in pre-op, you can direct me to her instead of sending me outside to a queue.

Luckily the cyst was benign - her surgeon ordered a frozen so she and her family were assured right away. But the surgery was complicated, so she was inpatient for almost a week. Affording me to visit her often, share gross and micro pics of her specimen, support the anxieties of her and her family. Catch up. I miss the hell out of our teenage selves. But in our long conversations we proved that we are both still here. Same people, future incarnations.

"Thank you so much for spending time with me this week."

"Seriously? I should thank you. I am normally buried in my scope. Well, except for when I interact with Dr. Woods and Dr. Music. But really you are a breath of fresh air. I am sorry for your circumstances, but proud to support you. I sign out 65 cases a day, and there's no way I could give each person behind them all the attention I have given you this week. But sharing your path, the gross and microscopic pics - makes me feel like a real doctor. I don't do this for other patients. This week makes me wish I could on occasion. And last week, this would not have been possible. I was super slammed. This is a crazy slow unusual week, and I am glad."

Texting her surgeon the day after her surgery made me realize how touch and go it was. She texted back, "It was like someone poured cement into her belly. There were so many adhesions from previous surgery. My partner and I felt like residents again. It was the hardest surgery I have done in practice. I can't imagine her pain tolerance - it must be huge. We freed up a lot of her bowel, she should be much more comfortable."

I hung out with her one afternoon while I was waiting to go to a late meeting. "They said it might be awhile before I can use stairs. I'm thinking of getting a bed delivered to the house."

"Well, that shouldn't be a problem. You are a furniture mogul, after all. Just call your peeps and have them deliver."

"LOL. That's exaggerating."

"Not at all." She and her family have many stores throughout the South. "I'm headed out early. Treadmill/yoga night for me - no kids. Hope you get a good night sleep. I'll visit in the morning, if you are still here."

Luckily she went home the next day. I got to celebrate the good news with her and her husband during an early morning visit by her doctor. When I went back to check on her late morning housekeeping was already scouring her room. I texted her, "I'm glad you are gone but I'm going to miss you so much - let's catch up soon over dinner and wine." She texted back, "Thanks again Giz, definitely soon." I may be her doctor, but I am definitely her friend first.

*Posted with her permission. And her appreciation. She's my first and best audience, and I'm so happy she likes this essay.

How Many Balls Can I Juggle?

I've been trying to dig deep and reflect on my own work-life balance... I feel like I'm living in a world in which my mantra to my learners and advisees is "Do as I say, not as I do."

I love to teach. I'm in an academic position because I thrive on teaching while working clinically. I teach medical students, residents, fellows and am engaged in faculty development. I'm encouraged by my mentors to "be academically productive" however I'm not entirely clear what that means. Write, publish, be educationally innovative, do research, stay sane and be a good mom and a good doctor. 

I need a new organizational scheme. My most successful portion of my organization is my google calendar. I literally cannot do anything without it. I've got it color coded and labeled. My week in view is dizzying with color coordination and notes. My to do lists, however, are scattered between different notebooks, notes on my phone, loose pieces of paper that find their way into the ether. I need a new work flow solution. I need to find a way to keep track of things and move my academic work forward in meaningful ways.

I sat down in a coffee shop the other day to try to make sense of it all and stratify things into columns and was overcome by this subtle feeling of butterflies and anxiety in the pit of my stomach. I've never really been ridden with anxiety, however this discomfort is rearing its head more and more frequently... feeling like I'm missing something, am forgetting something, am going to drop a ball, be found out as a fraud who cannot "do it all."

While I'm not junior in life, being a "non-traditional" physician, prior career as a nurse, I am early in my career as an academic physician. As such, I feel this pressure to continue to do things which further my personal and professional development. At the same time, I want to be sure that I am giving my son the time and dedication he needs from his mom.

As an ER doc, my schedule is widely variable, shifts in the day, evening, night, weekends, holidays. Sharing my son with his father affords me the opportunity to work academically without interruption about half of the time. There's still work which needs to be done when I have him. So, I try to balance it by not working while he's awake. Sometimes I'll have a random Tuesday free and we do arts and crafts, read, go to the park, ride bikes, run around playgrounds, run errands. These are the precious moments I hope he will remember and treasure... I know I do. We make meals together, he shares his days spent with my nanny and daycare and at night, I tuck him into bed, sometimes dozing with him. He looks at me beforehand, puts his little hand on my face and says "Mommy, I love you bigger than the Earth." After drifting off with him for a bit, I get up and set my sights on my late evening tasks... emails, curriculum development, evaluations, mentoring grand rounds presentations via chat mediums or Google Hangouts or FaceTime. 

I sit here sipping my chai tea, reviewing important dates for the next academic year, the next evolution of my growth and development as an educator, curricula which need updating and modification to be in line with current educational methodology, exploring alternative ways in which to teach and engage learners in an overall curriculum which has less and less "time" for what I feel needs to be included. 

I feel fortunate to have been given some incredible opportunities to take on leadership positions and influence our future doctors. How many of these am I capable of managing? Am I giving each of these precious opportunities the time and dedication required? Am I being the best educator and physician that I can be? Am I being the best mom I can be? Am I seeking out mentorship appropriately to optimize my productivity? Am I interfacing with the right people? Am I serving my learners to the best of my ability?

My life is a concept map.

Thursday, February 9, 2017

Unreliable Moms

I'm going to come out and say it:

It stinks making plans with other mothers of young kids.

They are never free.  It's either date night or a soccer game or a kids birthday party.  And if I do manage to make plans with one of my mom friends for a playdate or girls night out, there's a 50/50 shot that someone will start throwing up and it will get canceled.

I used to think it was just me.  That my friends were particularly unreliable or they didn't think I was fun enough to make time for.  Then I joined the Facebook group for my town, and it opened my eyes. Women will make a post saying they are desperate to make friends and they will set up a playdate for a bunch of kids at the park.  Then the very woman who complained she didn't have any friends will flake and say she can't make the playdate!

I had a conversation with the woman who started the Facebook group.  She told me she organized an event for the moms in the group, multiple people RSVP'd, she reserved a location, and then she was the only person to show up.  I told her the same thing happened to me when I tried to organize a book club for the moms.

It honestly makes me want to just have friends who don't have kids.

Tuesday, February 7, 2017

Well Intern Exam: Half-way through Intern Year

Do you have difficulties falling asleep or staying asleep? – No. I can fall asleep anywhere at any time. While I’m waiting for the garage door to open at home after a night shift. While my husband is telling me about his day. My kids have taken to telling me to drink coffee as soon as I get home so I don’t fall asleep while reading to them. The act of sleeping is not a problem. The time to sleep is the problem.

Do you engage in 150 minutes of moderate exercise per week? – Ha. I’m laughing to hard to formulate an appropriate answer. I run once a week for 30 minutes. On a good week I go to an exercise class. My fingers have become very nimble at typing.

Do you make time for family and friends? – My list of thank you notes to write is piling up. Nobody outside of immediate family got Christmas gifts this year. A rushed photo on Christmas morning texted to friends and family was our Christmas card. My kid has a birthday party coming up and I have no idea what we are going to do for it or how it’s going to get arranged. My kid’s teacher has introduced herself 3 times to me because she “doesn’t think we’ve met before.”

Do you wear sunscreen regularly? – I have the best skin cancer prevention practice - I don’t see the sun.

Have you had any unintentional weight changes? – Clinical medicine has been great for my midline. I can fit into all my old pants I outgrew in medical school!

All in all, Intern year is a rollercoaster of emotions and stress. Some days I love what I do and feel so lucky to be part of this profession. Other days, I look at the MA’s in the clinic and envy their ability to work regular hours with loads of time for pursuing interests outside of work. Some goals I’ve succeeded at this year, such as getting more efficient with day-to-day activities, working on research, reading everyday. Other goals have fallen terribly by the wayside, such as writing on Mothers in Medicine, being more involved in the kids’ school or seeing my non-work friends. I have a new forehead wrinkle (particularly unfair given I’m never in the sun). I’m lucky to have a supportive husband and awesome kids that (mostly) don’t make me feel guilty for working long hours. And my hairdresser lets me nap while he does my hair.

Now a little more than halfway through Intern year, I’m still happy I choose to switch careers and go to medical school. I’m still happy everyday (most days) I get to be a doctor. I’m taking that as a good sign. Now, to figure out the getting more exercise bit . . .

Friday, February 3, 2017

Let it Go

Let it Go has been stuck in my head, oh, maybe 3 out of 7 days of the week. On a good week. For at least a year. More? (This has to be causing some sort of permanent brain damage.) Despite anyone’s intentions to shield their children from Disney and princesses (including mine), Elsa, Anna, and the gang are a nearly inevitable part of toddler/preschool life these days (Mommy? Why do all my friends wear sparkly blue dresses every day?). My 3.5 year old daughter hasn’t even seen Frozen in its entirety, and actually doesn’t seem to really want to. She doesn’t even like Elsa in particular (She is firmly a Paw Patrol girl- she wants to be Skye when she grows up- yes, a puppy pilot. I encourage her to shoot for the stars, even if that means becoming a dog!). But there is something about Let it Go and the music video… she loves singing along and copying Elsa’s movements of shooting snow darts and letting her sumptuous braid down (which is hilarious by the way). And, as ashamed as I am to say this, I love it too- I think we’ve contributed to at least 1000 of the nearly 1 billion views on Youtube. Watching Elsa transform into this powerful, stand-up-straight, confident, unapologetic, gorgeous, and very sparkly woman is actually very enjoyable- she clearly loves her newfound boss-status.

The other night, she requested to watch Let it Go yet again, and I tapped the wrong video on Youtube- it was a short interview with Kristen Bell and Idina Menzel while they recorded songs from Frozen. I really loved what Idina Menzel said about the song. “It speaks to anyone holding back anything that makes them special and unique… What a relief to find those points in your life when you’re just able to let go and be completely who you are.” Nothing mind-blowing I guess, and very literally what the lyrics of the song say haha.

But I found myself thinking about it today as I hummed the song in my head while doing my tissue culture work. I think this past year has been my Queen Elsa metamorphosis. As Anna said when she first encountered Elsa in her ice castle, “Elsa… you look… different.” I, too, feel like a different woman than I was a year ago. I don’t feel like a terrified junior resident. I don't feel like a scared mom. I took a year out of residency to go back to the lab and do bench work and, thankfully, still love it and have found my stride. I got my first real grant where I am the PI. I chose my subspecialty training path and secured a fellowship position. We had a second kid almost a year ago and are all still alive. I no longer feel like everything is hypothetical in the future, but that there is now a path… that I’ve finally differentiated into the physician-scientist and woman that I want to be. I am owning it, standing up tall, and proud. It feels good. This is who I am and this is my life’s work. (I do wish it was something more exciting, like being someone like BeyoncĂ©, but maybe I can one day make biomedical research sexy) I realize that it is very sad and pathetic to be extracting profound life lessons from a Disney song, but hey, this is about as cultured as I get these days. May I hold onto this feeling for more than a fleeting moment (or at least remember that I once felt this way)…