Friday, June 29, 2018

Anxiety, Airplanes, and Albendazol

Last year I asked how long you mamas have been away from your critters (critters being kids) in hopes to find the inspiration I needed to do a 6-8 week global health rotation. 6-8 weeks turned into four. Four turned into two. (I chickened out of taking my two toddlers to Ecuador alone) Two turned into one when the organization I was going to work with was at capacity. One turned back into two, because goddamn it I am a fearless travel warrior and I'm going to spend a week alone in another country! Well here I am at the end of my two week stent in Panama. I'm laying in a hammock, looking into the lush mangroves, listening to the tropical birds, scratching the sh*t out of my Chitra bitten body. There are two versions of myself. The world traveler who wants to boldly experience life and other cultures. And the anxiety riddled girl whose heart rate is never below 120 on airplanes.

Lately anxiety girl has come out in full force. It started slowly last November when I had a panic attack. I had issues with this before, and thought that chapter of my life was over. Lack of sleep, the new stress of medical school, and stress at home are easy targets to blame.  I filed it away in the "pretend it didn't happen" drawer, along with that time I farted in 8th grade in front of the class. Well, the file kept growing. I didn't have anymore panic attacks, but I became quite anxious.  Most of the day I was ok but had these bolts of anxiety that would shoot up and like a Wac-a-mole game I kept hammering them down. I did a good job at not letting any of it show, but I was tired of constantly having to talk myself out of an anxiety attack. So I ignored popular rumors that seeing a therapist would ruin my career and went to talk to a school counselor for free. The first lady was a bit of a nut job. She told me I needed to pop a Xanax, not to date outside my race (while insisting she's not racists), gave me a list of 5 books to read (I don't have time for books I need legit CBT!), and rambled on and on about Brigg-Myers personalities. She also told my friend she may have a tumor on her adrenal gland, and that she wasn't cut out for medical school. Ya, I didn't go back. Months later I decided to try to school psychologist, for free again. First visit was okay. Just chit chat. Talked about stress. Ya, I'm stressed, but I think I handle it relatively well. Second visit I laid it all out. For the first time I spoke out loud about everything I have been experiencing in the past few months, and I realized how bad it all had gotten. I told her how I can only study in three places, because those are the only places I feel safe. If I try to study at a new coffee shop, I get anxious. I told her about how I had been having to call my dad for reassurance that I was indeed breathing when I felt like I couldn't catch my breath because of anxiety, sometimes at 3am.  About how I was constantly making up these worst case scenarios, like school shootings at my kids daycare, and car accidents when someone else was driving them. About how exams make me feel trapped. About how I was anxious about going to Panama, because I would be away from my safety net.

Just saying these things out loud made me realize that everything I was experiencing was indeed anxiety. This gave me hope. It meant that with therapy, meditation, and self awareness I could perhaps get better. And if that didn't work, a good 'ol SSRI could. She told me every time I am anxious about something bad happening, nothing bad happens. Yes, I'm going to get anxious, but I could use techniques to ensure the anxiety doesn't escalate. So do I want to be anxious at home, or anxious at a beautiful beach in Panama?

So off to Panama I went. The 15 minutes flying through a thunderstorm with lightning outside my window sucked, but I didn't panic. Getting motion sickness on the ten hour bus ride that felt more like riding through the Arctic sucked, but I didn't panic. Spending a day febrile in a room with no A/C or airflow sucked, but I didn't panic. (I went to the nice hotel across the street with ocean view and glass floors) I repeated the phrase "ebb and flow." Just like the tide, anxiety, fear, sickness, storms all come and all go. I would tell myself "this is something that could cause anxiety" so that when I started to feel nervous I knew the trigger, and the anxiety wouldn't escalate.

It's been two weeks, and I've walked hours on beaches, practiced meditative, freeing yoga, saw dolphins and bioluminescence, met some of the most inspirational, well traveled people, helped bring medical care to remote indigenous communities, got laughed at for the way I pronounced my patients names. (all in good fun). All this was completely out of my safety net. This is also what I love about traveling. It forces you to become uncomfortable. In this discomfort is where growth happens.

So now I go home feeling mentally stronger. More a fearless warrior, and less anxiety girl. Another 10 hour bus ride and 4 hour flight until I get to kiss my sweet babies. I hope one day to show them the world as it is. It is complex. It is beautiful. It is unique. It is painful and hard. I hope they learn to be uncomfortable, to move past fear. And I hope to bring back only memories from this trip, and not worms or Leishmaniasis.

Thursday, June 21, 2018

Disney, food poisoning, and a podcast

My husband took our son for his first trip to Disney for his birthday. Alas, sans me, I was working. But this post is not about any mommy guilt for missing his epic birthday Disney trip. My ideal vacation consists of laying on a beach and gazing into the blue ocean and blue skies. Minimal planning required on my part beyond transportation and lodging. I was happy to skip on the byzantine planning of Fastpasses and Mouse Hacking, and let my son make memories in the magic kingdom with daddy.

Father and son brought back lots of memories. But also food poisoning. On the drive back home, my husband was so violently ill, he didn't feel safe driving back. So instead of waiting a few hours to rest and recover, he suggested I drive several hours to meet him halfway and pick up our son. And he continue driving himself home. Because he must get to the hospital in time to get signout for his patients. Over the years of being married to him, I know better than to suggest logical alternatives to his crazy plans, especially if he is in any state of distress. Luckily that particular day was my day off. So off I was, driving in his general direction, hoping for their mutual safety.

On this drive, I tuned into an episode of one of my favorite podcasts, Hippocratic Hustle. And what a pleasant surprise to hear our very own PracticeBalance, talking about blogging in medicine as her side hustle. I very much enjoyed listening to your voice and your story, just as I enjoy reading your posts!

As a Disney ending to my absurd story, we all got home safely, everyone regained their health and lived happily ever after.

Wednesday, June 20, 2018

Living into our values

Hi everyone. I'm Peaches, which is a play off a goofy nickname my father made for me as a kid, and completely ridiculous (which is more or less how I am). I'm a rising 4th year med-peds resident, mother of a 10 month old, and wife of a teacher - I'm also a poet, distance runner, and currently baking a rhubarb cake while the remnants of tonight's dinner are crunching under my feet (thanks, Z). And I'm posting this after coming off of night float; some un-edited reflections on where we are now (and hope for some advice from fellow comrades, waving in the distance).

Sometimes I think I do my best reflecting on my life while on the middle of night float, at 2am, sitting at a workstation computer and overlooking the rooftop garden where the cancer patients spend their days, walking the 30 yard loop and enjoying a small taste of sunshine.

I’m always so cranky on night float. It might be one of the worst parts of residency – not even the forgiving 28 hour calls, where I come home and nap in the blissful quiet while Z is at daycare and my husband is at work – but the rhythmically monotonous night float: come home at 9am, putter around cleaning and then fall asleep, sleep until 3, wake up and go for a run, go get Z from daycare, spend 2 hours with him, put him to sleep, spend an hour with my husband slash frantically shower, pack lunch, try not to argue about the mounting mess in the kitchen or the unfolded laundry – and go off to do it all over again. I’m not sure if it’s the lack of sleep, or the frenetic-ness of never being home for more than two hours, but I worry that my family doesn’t get my best self. It’s not until midnight or 2am that I feel fully awake and functioning clearly.

Hence, the 2am reflecting.

We’re looking for a new daycare, which I never realized would be as stressful as it is. We have one that we like, and has done a wonderful job with Z, and most of all, had a place for him the second we called. Z is our foster son, who was placed with us at 4 days old, and has been with us ever since. And since 6 weeks and 1 day old, he’s been at this daycare ever since as well (my two week maternity leave can be a post for another time…) As we’re in the process of adopting him, we’re also getting more skeptical of the completely chaotic 2+ year old classrooms, and looking at other daycares nearby.

But it’s so stressful, trying to figure out how to live into these values we’ve talked about for years, which are sometimes incongruous – wanting a place that is diverse, with kids who look like our biracial son, with teachers who he can see as role models; a place that is close, because we love having only 1 car and I bike commute and want to be able to pick him up; a place that is invested in his emotional development and has a small teacher:student ratio, because he has a lot of barriers he’s already had to overcome (and will still have to overcome) related to his early-life experiences; a place that teaches kindness and reading and self-control (which are pretty much the only goals of daycare, I think). And what if all of these aren’t together? What if the diverse, close-by place also means my husband has to come to work an hour later everyday (not a possibility) or the emotional-IQ, small teacher:student ratio means I can’t bike to pick him up early? Or the 3rd option, the really nice supervisor and lovely outdoor space – they want him to only spend 9 hours maximum, and will fine us (and judge us) if he’s there longer (side note: have they ever met a resident before?)?

How do you figure out what things to prioritize the most?

It’s easy to espouse values as a young adult. It’s harder to practically live into them, to put your money where your mouth is, to live in the city instead of move to the suburbs, to send your kids to public school when the private school has a lot cooler opportunities – these are things I felt so clearly confident in, when the choice was theoretical. I understand the shades of gray involved in all of these things, now, more than I did before. I’m not sure what’s right for us now, always.

Sitting out in this garden, now, I can look out at the city below me – it’s dark, with the lights of the highway blinking in the distance. On my left, the tower of the cancer center rises, and the stairwell is encased in all glass and lit such that it glows, and I remember nights spent sitting on the landing between the 14th and 15th floors, eating a granola bar and staring out to where the sea meets the shore. We are all connected here, I know, and it’s odd how the sense of panic I felt sitting on this bench as an intern has morphed into different types of questions. The hypotensive patient or the guy whose sats keep dipping into the 70s feel like the easy ones.

Tuesday, June 19, 2018

Doctor-Moms, This Is Our Job

Finally, a cause we can all agree to take action on. We means everyone: Liberals and Conservatives, Democrats and Republicans, Christians and Jews and Muslims and Atheists and everyone in between. Follow to the end for specific, easy actions you as a physician and a mother can take to help stop this morally repugnant horror.

The issue? Around the world, we are seeing a horrific trend: children are increasingly being used as tools in political conflict. In Syria, children are used as human shields. In Afghanistan, children are recruited and used as soldiers. In Nigeria, children are recruited as suicide bombers. In Myanmar, children are tortured to send a political message.

Here in the United States, we take children as political hostages.

This is no exaggeration nor overstatement. This Saturday, our President stated that he is using  migrant children taken from their families as a political bargaining chip. Despite his repeated insistence, there is no law nor policy in place stating that migrant families should be separated at the border, only President Trump's personal mandate.

How could such a horrible thing happen here, in our democracy? In Spring 2017, Trump's Homeland Security Advisor John Kelly proposed separating all children from their parents as they sought shelter, “in order to deter more movement along this terribly dangerous network”, as reported in last week's New York Times.

More recently, Trump's senior policy advisor Stephen Miller reiterated that this is all Trump's doing: 

It was a simple decision by the administration to have a zero tolerance policy for illegal entry, period. The message is that no one is exempt from immigration law.”
It is now well-documented for the world to see and judge. In using children as political hostages, our country has stooped to the same lows as terrorists and dictatorships in Syria, Afghanistan, Nigeria, Laos, and Myanmar.

Of course there is growing outrage against Trump's disgusting agenda. Many Republicans leaders are stepping forward to condemn this administration's inhumane actions, and not only moderate stalwarts like former First Lady Bush and Senator Susan Collins of Maine. Even Senator Lindsey Graham of South Carolina has gone on record, stating "President Trump could stop this policy with a phone call",  as Monday morning's New York Times reports.

While he is unlikely to take any action, we can.

We are mothers and doctors. We are uniquely positioned to comprehend the psychological damage inflicted upon children who are forcibly removed from their caregivers. The American Academy of Pediatrics has vehemently opposed this as policy since it was first mentioned by Trump's administration last Spring, based on the known grave consequences to child development. Pediatricians are speaking out. AAP president Colleen Kraft described the heartbreaking grief of a toddler she witnessed at one detention center, and explained the effects of harmful toxic stress on children.

As the AAP's formal statement on The Detention of Immigrant Children recognizes:

"In accordance with internationally accepted rights of the child, immigrant and refugee children should be treated with dignity and respect and should not be exposed to conditions that may harm or traumatize them. The Department of Homeland Security facilities do not meet the basic standards for the care of children in residential settings."

The American Psychological Association has also written a letter to the Trump administration in opposition to the policy:

"Families fleeing their homes to seek sanctuary in the United States are already under a tremendous amount of stress. Sudden and unexpected family separation, such as separating families at the border, can add to that stress, leading to emotional trauma in children. Research also suggests that the longer that parents and children are separated, the greater the reported symptoms of anxiety and depression are for children."

Yes, it's pretty clear that ripping innocent, frightened children from their parents and locking them in chain link cages is not in accordance with internationally accepted rights of the child. So what can we do about it?

As little or as much as you want. This can be simply clicking on a link to sign a petition or donate to a vetted charity, to calling your representatives, to writing an article for a local newspaper or blog... It's up to you. Here are some suggestions (and I personally did every single one of these this lovely Monday morning before my clinic started):

Petition to Donald Trump to stop separating families at the border:

Petition to the Department of Homeland Security to stop separating families at the border:

Petition to Secretary of the Department of Homeland Security to stop separating families at the border:

KIND (Kids In Need of Defense) is a nonprofit that provides legal assistance children who would otherwise stand in court alone. 

The Florence Project is a nonprofit that provides legal assistance to political detainees, including children, in Arizona.

The Asylum Seeker Advocacy Project is a nonprofit that provides legal assistance to refugees feeling violence seeking safety here int he U.S.

RAICES is a nonprofit that provides legal assistance to detainees and refugees, including children, in Texas.

Al Otro Lado is a binational nonprofit that provides legal assistance to families who have been separated, navigating the legal systems of Mexico and the United States to bring them back together. They also help deportees who have been abandoned in Mexico with resources including medical care.

Families Belong Together is organizing rallies and protests in opposition to separating families at the border. Check out their website to see what's happening next near you.

This is actually one of the most powerful things you can do. Call your representatives using any of the below easy methods. You'll probably get an answering machine, but if you get the machine or a person, say "My name is (your name) and I am opposed to separating families at the border. I am from (your zip code) in (your state). I do not need a response.":

Find your representatives in the House and then find their office phone number, and call.

Find your representatives in the Senate  and then find their office phone number, and call.

Or just call the Capitol operator: 202-224-3121. This number will direct you to the Capitol switchboard. When you call, ask to be connected to your senator or representative. The operator will direct your call to their office.

Pending Legislation on this includes The Keep Families Together Act and The Help Separated Children Act

Whichever of these relatively small actions you take, TALK about it, SHARE on social media, PUBLICIZE the cause. This is really powerful.

WRITE: You are a doctor. You have a platform. Your voice is heard. Please consider writing a letter to your editor, even if it's a small town newspaper. Consider writing an op-ed for a news outlet. Consider posting on a political website, as Sanjiv Sriram, MD did. Consider writing a guest post for a blog. I accept guest posts at my own personal blog , and the editor here at Mothers in Medicine does as well. Kevin, MD is another great place for physicians to share their educated, intelligent thoughts.

Whatever you do, DO SOMETHING. The policy of using children as a political tool is morally repugnant, and we as doctor-moms know this better than anyone. Please help to stop this moral slide into evil.

Sunday, June 17, 2018

We Are All Elastigirl

At my house, we are The Incredibles. The first time he saw the movie, my oldest son identified immediately with Dash, the blond little boy whose super power is to run super fast. Naturally that led to him insisting that everyone call him by that name, then that everyone call his little brother Baby Jack Jack. For the past year, he has also called my husband Mr. Incredible and me Elastigirl. (Seriously. When he started preschool last fall, we had to have several talks about how he could still be Dash at home but had to use his real name at school.) My younger son, who is 2, also calls himself Jack Jack (though thankfully he also knows and can say his real name), and now has a pretty clear pronunciation of my husband's and my Incredibles names. I'm not sure we'll ever go back to our non-super identities.

As you might know, this weekend is the premier of The Incredibles 2. The other day my nanny took the boys to McDonald's, where they each got a Happy Meal containing an Elastigirl toy. The moment I got home from work, they were clamoring to show me the toy - Elastigirl riding a motorcycle - and the way that it expanded to simulate the way she stretches to incredible lengths when fighting the bad guys.

It got me thinking about how, even beyond the fact that hers is the name I have answered to for a year or more, I actually identify with the character. 

I get that she had a super-impressive career fighting crime, but that she shifted her focus to her family in ways she never expected. (At the beginning of the first movie, she says in an interview, when asked about settling down, "I'm at the top of my game! I'm right up there with the big dogs! Girls, come on. Leave the saving of the world to the men? I don't think so.") That she still has the skills to take on villains, but somehow is able to attend to her children's needs at the same time, all while gracefully adapting to every unexpected turn of events, like flying off to rescue her husband and learning that two of her children have stowed away on the plane. I feel that long look in the mirror when she checks out her backside in her new super suit. I was skinny once, too....

Image result for elastigirl  looking in mirror

Elastigirl quite literally stretches everything - her arms and legs to reach things when sneaking into a compound or doing battle, her expectations when she believes her husband is having an affair but also knows he is in danger so goes after him, and her plans when they go astray as they so often do. It's no accident that, as they return home from taking down the robot monster, while Mr. Incredible and Violet (the oldest child) and Dash recount the amazing moments from their fight, Elastigirl is the one on the phone checking in with the sitter to make sure Baby Jack Jack is okay.

And when he is not, when it becomes clear that the villain Syndrome has kidnapped him and is about to get away in his jet, it is Elastigirl who creates a strategy and quite literally goes after him. "Bob," she says to Mr. Incredible, "throw me!" After grabbing her son, she stretches her body into a parachute and cradles him as she delivers him gently back to the ground.

Image result for elastigirl parachute jack jack

I don't actually have any super powers - I imagine that life would be so much easier if I did - but I'm quite proud to be compared to Elastigirl. She represents what we working moms do: stretch ourselves in every way possible and do multiple things at once  in an attempt to care for everyone who is important to us, no matter the situation. You are all Elastigirl, too. And I'm proud to stand (and stretch!) among you.

Friday, June 15, 2018

After every winter, spring...

always comes.


But my life's progression to "spring" was blocked by an awful behemoth in my path--and I could see glimpses of this thing titled "spring", but I couldn't get there. So it has been a long, long winter, and I have been away from here for a long time. This thing, divorce, loomed in my life for a while, sat in my way, blocked my life and taunted my psyche. It was this big, ugly, hulking, ill-defined beast that sat defiantly between me, peace, happiness, future. It blocked the path between who I was and who I wanted to be...who I had the capacity to be. And avoiding it was causing me to become a person I increasingly disliked. So I introduced myself to it, squared up my shoulders, battled with it, and took it down. I ran, leaped, tripped, yelled, triumphed, paid (tears, money, frustration, adrenaline, fear) and then, officially---it was....over. The ink was dry. And truth be told, the marriage was over long before the divorce was--just as a piece of paper doesn't make you truly married, a piece of paper doesn't make you truly divorced. These pieces of paper simply symbolize what has already taken place in your heart, I believe. And they exist for the protection of property and children. That is all.

The initial months after my ex-wife moved out were a blur of pure relief, loneliness, freedom, calm, financial stress, happiness, and much needed solitude. I never looked back. I never doubted my decision to leave, not one time. I knew I'd done the right thing, as hard as it was to enact. As time passed, I dated a few women, but no one in particular really struck my fancy. I never found anyone who I thought was really special. Nice, kind, smart, attractive? Sure. But that wasn't enough to keep my interest in anyone in particular, and after a while the dating world was....tiresome. I had no real connection with anyone, no real chemistry. The thrill of being single, being free, being wanted, flirting was...getting dull. There I was wandering aimlessly around a romantic virtual world, without any real destination in mind. So I'd delete the app for a bit, roll my eyes, and drink/hang with friends. Onward....maybe someday I'd find someone again, but I sure wasn't in ANY rush--the very last thing I wanted was A Real Girlfriend. I didn't want to be anyone's person--I didn't want the obligations, the expectations, none of that. I wasn't sure I could do that again. Been there, done that, and in some ways----I'd failed miserably. It had been such a tall order before and I'd not measured up....right?

While I dated casually, I also worked to heal myself from the damage that our marriage had caused.  I was in therapy, and I fought to delete the list of ways that my ex-wife had said I'd failed her, failed our marriage, failed our children--all by initiating the divorce, which was the only way to a better life that I knew (after thousands of dollars in marital therapy and two separations). I realized that I had recreated my self-image according to her feedback, not my self-knowledge (or the knowledge of others who really know me)--and I was angry and disappointed in myself for having done so. I had actually believed all of the things she'd told me about me--things she'd said over the years out of anger/need/frustration/hurt, time and time again, as I repeatedly failed to meet myriad unspoken and seemingly mysterious and randomly presented expectations and needs.

I didn't know what was true anymore, and it was terrifying. Was I Person A or Person B? I fought to redefine (rediscover, really) myself for myself, to believe my voice about myself instead of her voice/story about me--and it was impossibly hard at times, and I did not always succeed. Some days were interminably long and painful,  and I worked to feel valuable, attractive, intelligent, worthy of anything--love, respect.  I worked to make eye contact with another human, some days. I worked to summon the energy to go to work, to engage with my patients beyond lab data and physical exam findings. My therapist was my reality check, when I wasn't sure which way was up some days, when I wasn't sure who I was anymore.  She was my mirror through all of this--she showed me the little tiny bit of myself that was still there, that was unchanged, the essence of ME, that was going to be ok--that had always been ok and that always would be--no matter what. Her unwavering belief that I would be ok was steadfast and solid; some days I counted on her belief in me far more than I ever believed in my own ability to be ok. I had to take her word for it. And I did. And some days, it saved me.

Fast forward a few months. The dust had firmly settled. I could see the good in life again. I realized that I am an ok person. I was in a new routine with life, work schedule, kids. I was single. Spring was I think? I felt pretty good in my body, my mind, my heart. I'd dated a bit, and it'd been fun. I I was happy, and not seeing my therapist as much. The worst of things was was looking good again. So I opened a dating app, while I was standing in the middle of my kitchen--and I don't know what made me do it, I just... opened it. And there was one of the most handsomely gorgeous women that I'd ever laid my eyes on--my inner dialogue was "Oh my goodness....!", I had a run of a-fib, and I sent her a message. And I wasn't so sure I'd hear back...I mean, she was so damn cute and...I'm But something about her simply took my breath away. Something.

Well, I heard back. And back. And back some more. And now we're heading into our sixth month of dating and I love her in a way that I didn't think my heart was capable of loving. Nor did I think my heard was capable of receiving such love. I have loved before, and she has loved before--we've been on the planet too long to not have, and the loves we have had have helped craft us into the humans we are today--and for that I am thankful for us both. But I've never loved like this before. It's different; it's more complicated. It's more complete. And I didn't know that this kind of love, this kind of seemingly unconditional love and non-transactional love--the kind of love where someone loves you simply for who you are--not what you do for them, the money you make, what you say or what you look like or what you provide now or could provide or anything else---could ever be a part of my life-I assumed it would forever be beyond my reach, that it wouldn't happen in my lifetime. Thankfully, I was wrong. "BB" suddenly landed in my orbit and I knew that spring had definitely arrived.

To be continued...


Thursday, June 14, 2018

Hello from Ticketyboo

I am so excited to be a new contributor to this awesome blog for momma docs. 

I’m a Canadian internal medicine resident in the early years of training. My spouse is also a resident, and we became parents to our wonderful baby boy earlier this year.

Thanks to Canada’s parental leave policy, my spouse and I were each able to take approx. 6 months of leave to spend with our little one (really lucky, I know). I took the first 6 months, because of childbirth and breastfeeding and all that jazz, while my spouse is taking the last 6 months. The shared leave is supposed to help coordinate our residency completion dates, and make some of my upcoming hectic rotations more manageable. Pre-baby, I also felt strongly about sharing the “primary parent” role with my spouse. Now, I see taking care of our baby more as a treat rather than as a responsibility to share (that’s what bonding will do to you I guess!), so I’m doubting my initial reasoning. It’ll be interesting to see how we feel once our year is up. 

My time of full-time snuggling with bébé is almost up and I’m soon returning to residency. Even though I know I’ve been very fortunate to have MONTHs of time with our little one, I’ll nonetheless miss him tons while I’m away doing the resident thing. 

In the next year, I’m hoping to share my experiences as a resident and mama, attempting to balance it all (or realistically, just survive it!).



P.S. My pseudonym is an infrequently used Canuck expression that means “going fine” (e.g. “everything is tickety-boo”), which is how I hope life will be going in the coming months/years. Also, I think “tickety-boo” has a nice ring to it, although it does sound like something you might name a teddy bear...that’s not bad though, right?  

Morning Routines: Is There Such A Thing As A Mother In Medicine?

Years ago, I wrote this blog post about morning routines and how much I adored my "slow" non-workday mornings. I was in the midst of a 3-year IVF journey, but I wasn't pregnant yet. A friend of mine, who at the time had a small baby, laughingly said in response, "That sounds blissful, but wait until you have kids!"

So what's my routine like now? It's still a bimodal scenario: as a part-time anesthesiologist, the morning "routine" varies dramatically depending on whether or not I'm headed to the hospital. On a morning when I don't have to work, the old way I described of waking up to the natural dawn of the sun is a thing of the past. In contrast, many of my mornings start with my two year old daughter either crying or yelling, "Mommy!" I stumble into her room, change her diaper and make her bed/assess for any damage that might have occurred in the nighttime. I may or may not have been in there multiple times during the night prior to the actual wake up. We head out to the kitchen and immediately take our vitamins (me and her), drink a large glass of milk (her) and make a large cup of coffee (me). I tap dance around my husband in the kitchen, which despite being adequately sized, feels like we are bumping into each other constantly. Here's where the "slow" part comes in: we have a little time to chill, play, hug, talk, etc. Eventually we make a breakfast, usually eggs +/- bacon. Once the sun comes over the mountains, we take the dog for a walk to the park.

Those last steps are especially important to me, since I definitely don't make food on my workdays. In fact, on those days I have no idea what my daughter actually eats for breakfast. One thing that has really helped to smooth over my (sometimes rough, always rushed) workday mornings with a baby and a husband with his own agenda has been to hire what I call our Morning Nanny-Taxi. This person comes to our house at 6 AM, plays and takes care of our daughter, gets her ready for the day, and then drops her off at her daycare/preschool at 8 AM (she only goes on my workdays and a smattering of random other days). I've found that this is well worth the market price for 2 hours of service by a driving babysitter. Amazingly, there are people who will do this! Many of the people I've interviewed for this position have another job that is either part time or has a later start time. The few wonderful women we've hired so far were found through websites such as Sitter City and (Note: I am in no way affiliated with these sites but have used them successfully to get good babysitters. I would also offer the opinion that Sitter City's pool of applicants seem more suited to random and part-time work as opposed to Care, which tends to have more applicants for regular or full-time nanny work.) While our household is very often awake prior to 6 AM, I don't have to leave for work on my workdays until 6:30. This little half-hour buffer gives me a small chunk of uninterrupted time to get ready, which I now relish just as much as my old pre-baby slow mornings.

You can find mommy blogs and parenting books everywhere that stress the importance of a consistent, daily routine in children's lives. Important for what? My daughter seems to be doing fine despite our undulating schedule. With complicated call schedules and specialties that rely on shift-type work structures, I'm sure I'm not the only mother failing at the routine game. And what about double-doc families? More than one child? Large age ranges? The complexity multiplies...

How do you deal with mornings?

Tuesday, June 12, 2018

Intern Year Recap

Intern Year Recap

As my kids end school and I start power- reading to get ready to be a 2nd year resident, I want to take a chance to recap this crazy roller coaster/ transformative/ at times impossible/ at time inspirational year.

Top 10 ways to rock intern year.

1. Make friends with your co interns. Your nurses. Your seniors. Basically, anyone in the hospital. It is the place where you will spend the bulk of your time, so having people you look forward to seeing, talking to, working with, will make the tedious hours go by shorter, the hard times a bit easier, and the terrible days a little less terrible. You may even have fun.

2. If you ever are doubting your abilities, teach something, anything, to a medical student. You will be amazed at how much you actually do know. You will help them learn something. And you will feel like a better, kinder, and more capable person for it. Teaching also helps solidify information, so if there is something you struggled to know the day before, teach it to a medical student today. Believe me, it is a huge ego boost and a way to help out someone who will one day be your colleague.

3. DO NOT LIE. If you didn't order a test, or do a complete exam, or replete lytes, or order an antibiotic, DO NOT LIE. Just be honest. Admit mistakes, and work to correct them.

4. Invest in really comfortable shoes. I wore worn out tennis shoes for 6 months and my feet ached. every. single. day. When I finally bought a better pair of supportive, soft, arch-supporting shoes, I felt 100 times better at the end of a shift.

5. Check in with yourself. At some point, I realized that I (a little curvy to begin with) had gained 10 pounds during my first 6 months of residency. Check in. Run, Exercise, Eat right. Come up with a plan. Bring lunch instead of ordering in or buying cafeteria food. Skip the muffin at the free breakfast. The past month I have been committing to 2BMindset (on the Beachbody website) and I lost those 10 pounds. It was a lot of effort and commitment, but I feel better, healthier, and am inspired to keep on a weight loss track to lose the rest of the "curvy" that still has me 20 pounds over my pre-baby weight.

6. Find something you love and make time for it. I love cooking. I stalk instagram food bloggers, hoard too many cookbooks, and screenshot recipes compulsively. Cooking gives me a creative outlet and also lets me feed myself and my family in a healthy, affordable way. Having an outlet outside of the hospital is essential for your wellbeing.

7. Drink water. Being dehydrated is awful.

8. Remember your "Real life" friends. There was  period of time where I had not spoken to my best friends (non medical, live in a different state) in over 2 months. I missed the birth of their babies, kids' birthday parties, their birthdays. I felt terrible and lonely. I just wanted to go home and give up. Luckily, face time and whatsapp goes a long way and I was able to realize why I felt so lonely and make an effort to reach out. Don't forget those who loved you and supported you along the way.

9. If you have a significant other/partner remember them. Try not to come home so utterly depleted that you have "no nice left to give." Your relationship deserves it.

10. Make every day a learning day. and try to end every day with positive thinking.  When you get home, think about 1 thing you learned. Think about 1 thing that made you happy. Think about 1 think you are excited to do tomorrow. (Bonus: think of 1 thing you did to make someone ELSE happy.) Thinking positively and productively will help you sleep better and be happier overall.

* Bonus- remember that your kids will think you are the coolest person ever no matter what. Love them unconditionally, the way they love you. If you only have energy to cuddle in bed, then do that. They don't care if laundry isn't done. One thing I learned this year is that my kids are freakin awesome. Resilient. SO. Much. Fun. Way more social than I am. Adaptable. And as much as I feel like I am never home, they have taught me to appreciate the time that I am.

Off to Year 2!

Friday, June 8, 2018

Reasons to Wear Lipstick.

It's a peculiar thing being a single mom, 30, and a first year medical student. At the med school parties, I'm 8 years older than everyone. In the hospital, I'm 8 years behind on my training than physicians my own age. At my kid's daycare, I am that parent that hasn't a clue it was my turn to pay for pizza Friday, or it's the teachers birthday. The other non-traditional parents in my class live with supportive spouses, so it is hard to fully relate to anyone. I like the uniqueness of my life, and on multiple occasions do classmates and strangers tell me how inspiring I am. But, I also admit it is quite lonely.  I moved into a new apartment with my 2 and 3 year-old last year. It was the first time I had to live alone with two toddlers. My life was study, change diapers, study, take the kids to beach, study, clean, study, yell at toddlers to stop drawling on the walls, study... It was a crazy adjustment, but I rocked it, mostly, after I found a good balance between those two heavy identities of mum and med student. (Finding that balance took a lot of tears, complete break downs, sleepless nights, fits of being woken by crying toddlers at 4am before a final, lots of use of a babysitter etc. etc). After three months of nothing but late night study sessions in the library, alternating with being Mom, I wanted an escape. Something fun. Something easy. Something to take my mind off of my chaotic life and make me feel like a normal human again. So I got on Tinder. Yes, that awful addicting dating app/hook up site for people like me who are incapable of meeting someone the old fashion way through mutual friends or some serendipitous moment in a coffee shop. The swiping happened, the chatting started, and the harmless fun of it was a light and easy way to wind down at the end of the night. Like how normal people watch TV, I ask completely random attractive men about their lives. I finally got ballsy enough to meet these completely random attractive men in real life. Of course only on weekends after tests when I didn't have to study as much. My basic day to day attire was messy bun and yoga pants, so it was so nice to wear real clothes again! I went Salsa dancing on the beach with a CT surgeon, played board games at a bar with a teacher, picnicked by the water with wine and a book with an IT guy, watched a play with a lawyer, drank more wine and watched the sunset with a pediatrician. It had been 5 years since I dated, and the timing of course is terrible as being a mom and med student makes an impossible girlfriend. But the experience, fun, and connections are just what I need to take me out of my diaper/molecular biology bubble.

Turns out some of my classmates are also on Tinder, so now study breaks consist of swiping and comparing baes (yes I started saying bae, I hang out with 22 year olds). Definitely no Mr. Right in the near future, but I will update y'all if anything crazy happens. Not crazy like the time my date showed up hammered after 5 shots of Whiskey. Just hoping for more wine, sunsets, good conversations, and a reason to wear lipstick.

What are y'alls reasons to wear lipstick?

Monday, June 4, 2018

Learning how to self advocate for wellness and career advancement

I've recently been meditating on personal and professional development and in a lot of ways, maintenance. Part of it aligns with recently discussed concepts of wellness and work-life balance. Part of it also has to do with this intrinsic unsettled feeling I'm experiencing with work. I attended an academic conference recently which I believe was clarifying and is helping me to frame my approach.


This all started with a dive into self care, specifically, trying to make sure that I was taking better care of this 41 year old body of mine. I had not been to a dentist in 15 years. Yes. You read that correctly. I had not seen a dentist since before medical school. Part of it was because I'm irrationally terrified of the dentist... part of this fear probably came from all those times my mother forced me to sit with her and hold her hand through many root canals and extractions while she squirmed, wiggled and held a vice grip on my hand. The other part of it was the silly thought, "If it ain't broke, don't fix it." The final factor was the disease of busy. I flossed. I brushed. I have a nice smile. I'm fine.

It wasn't until my little one bravely sat through the first couple of dental appointments during which we found out he had multiple cavities between all of the molars, necessitating 8 crowns, a failed attempt at in office nitrous and subsequent trip to same day oral surgery center with a pediatric anesthesiologist that I finally made an appointment. So I did it. I had a couple of cavities, needed scaling (which is a special kind or torture) and am now getting teed up for a root canal. I suppose it's not bad for 15 years. At least I'm keeping all of my teeth, for now.

Let's move on to fitness. I'd topped off the scale at 5 pounds over my full term pregnancy weight. I hated what I saw in the mirror. Inside I was happy. My outside didn't match my insides... maybe I wasn't happy. Regardless, I've spent the last year trying to make sure to make time to do tedious things like plan healthy and nutritious meals and get some exercise. I found a colleague and now friend who was an online health coach. I found a supportive environment of other busy, professional women who found time and prioritized this portion of self care and found that they ended up being happier, more patient and feeling more fulfilled all around. I found tools which were easy to implement (albeit requiring some behavior change), accountability partners and fun exercise options. I enjoyed it so much that I myself became a coach.

With everything we give to our patients, our learners and our hospitals, we absolutely must prioritize ourselves in there somewhere. Working out may not be your thing, but you have to identify what it is that recharges you and make time for it. Put it on your schedule or it will not happen. It will ebb and flow, but you've got to take care of you before you can take care of anyone else.

I still need to schedule that Pap and Mammo... I'm a work in progress.

Personal Development

Part of the company's philosophy is ensuring that you spend some time each day on your own personal development. This created an opportunity for me to read some personal development books (the former four letter "self-help" category). Below you will find the books I've gone through over the last 6 months (good grief, whoever created audiobooks is literally the best because I become narcoleptic while reading).

I've read (or listened to in audiobooks) "You are a Badass: How to Stop Doubting your Greatness and Start Living an Awesome Life" by Jen Sincero. She's not a physician, but she's been through some things and many of her struggles and insecurities resonated with me. She is also remarkably sarcastic and funny and I had many a laugh while listening to her book.

I followed that with "The Compound Effect: Jumpstart Your Income, Your Life, Your Success" written by Darren Hardy. This dude for all intents and purposes is a self made gazillionaire and did it all with hard work and discipline, specifically with small changes every day. He had an authoritarian for a father, so we have that in common. It focuses more on the business world, however if I ever consider entrepreneurship, I'll probably revisit it.

I followed that with bits and pieces of several books from Brene Brown... "Rising Strong" and "The Gifts of Imperfection," both of which hit chords with me. Let's figure out how to pick ourselves up after we fail at something because that is what bravery truly is. It takes no energy to stay down after you take a hit. Facing the day, reflecting on how you may have been responsible for whatever you've experienced is an important lesson. Reading her book is like sitting in a therapist's office, without the $200 price tag. She's a shame researcher and she hits the nail on the head when she discusses the mountains of self imposed guilt we shoulder unnecessarily. She's also witty and sarcastic from time to time.

Next was "The Subtle Art of Not Giving a F*ck" by Mark Manson. Now, if you can move past the fact that this guy is a bit like a frat boy in his use of language, there are some important lessons to be learned. Some things just don't deserve our energy. Seriously.

My latest read is "Feminist Fight Club: A Survival Manual for a Sexist Workplace" by Jessica Bennett. I came upon this book on my way to the aforementioned conference. I knew I was specifically attending a workshop designed to appeal to women interested in leadership in academic medicine. I was looking for something which would light my fire and help me think outside the box a bit. Jessica Bennett is a journalist who specifically writes about issues of gender, sexuality and culture. In her book, she highlights the research which discusses not only how institutions may unknowingly or overtly be preventing growth of their female professionals, but also behaviors we may be demonstrating which hinder our own progress.

I take each of these books with a respective grain of salt, but it's really kind of opened my eyes to some self reflection and highlighted some things I may want to work on within myself. When we spend so much of ourselves in tending to other's needs, our own needs and need for growth can get lost in the mix.

Professional development

So, I'm an academic. I teach medical students, PA students, residents, fellows, faculty. I have sought opportunities to develop my educational niche, my ability to provide feedback, teach a skill, develop a curriculum, pitch an idea to my department chair. I teach a lot of things... probably too many things, which is why I find myself feeling stale and unfulfilled here. I feel like I've spread myself so thin that I'm doing an ordinary job at all of the things for which I'd prefer to be doing an extraordinary job. I feel like an octopus juggling knives which are on fire. Is this imposter syndrome creeping in? Perhaps, but I know I could do better with my time and efforts if I peeled away from some things.

I officially mentor some and unofficially mentor others. I've not received any training per se in mentoring, save observation of folks I hope to emulate. I don't know what the steps are. I don't know what skills to hone. It's kind of like teaching, but also very different from teaching. There should be a program for mentoring the junior mentor. There probably is, but I've not yet had the bandwidth to seek out or discover it, but it is something I need. What I found most interesting in the sessions at this conference was the focus on not necessarily seeking out the most sage mentor. Sometimes peer mentors are actually better for you as you navigate different challenges in your career.

I've been at this academic gig for 6 years now. At the conference I attended, many of the female leaders commented on "cycles" and feeling unsettled after a certain amount of time doing each of the jobs they did. That hit home for me. I feel unsettled. I want to do what I'm doing differently and I need to advance my position from my current title to the next. As such, I've been meeting with my closest mentors, having heartfelt talks about what I thought I wanted when I started, what I've done and where I see it going. I see now that I've invested a tremendous amount of time and emotional capital in one path. It was my hope that by working hard and contributing, I'd be rewarded with position. Boom!!! Words from all of the books came to mind and highlighted for me that I in fact cannot do it all and I should be asking for compensation in some way for what I am doing. You will not get 100% of the things you DO NOT ask for. I must focus my efforts on those things which are most meaningful to me in my professional life. I need a new goal. I need a promotion. So, I'm going to spend the next couple of months working on my dossier, writing papers, reviewing and revising the curricula that I am responsible for and pouring the energy freed up by letting go of tasks held by one of my octopus tentacles.

It's exciting and anxiety provoking to have this new approach and challenging in that I've never before created a dossier or gone up for academic promotion. Why didn't someone tell me about all of the stuff that goes into this? Why didn't someone tell me to keep better track of all of the lectures I taught, programs I developed, mentees I invested in, meetings I attended, evaluations I received??? This wasn't part of orientation when I became faculty. It was discussed as an afterthought in my annual meetings "You should be ready for promotion in a couple of years." After reading my most recent book, I wonder if the experience is the same for my XY colleagues. Is the assumption that because I'm a single mother, I must not be interested in promotion or advancement, so I don't really need the guidance or personal investment? To adapt a quote from Jessica's book, "No one gets shit done like a mom."

I'm trying to figure out what my professional and personal mission statement is. What are my values? What do I hold dearest to me? Do my actions align with my values and my mission? How do I parlay these reflections into actions moving forward and be sure I'm looking out for my own professional interests, professional development and advancement?