Tuesday, March 12, 2019

Grappling and Grateful

I’m nesting.

No, I’m not pregnant, and I’m not sure when it started exactly, but with the start of residency looming and more free time on my hands right now than I’m used to, l have this strong desire to declutter and reorganize. Thanks in part to a nudge from Mommabee’s recent post on feeling stuck, I dove into Marie Kondo’s Netflix series.

I hoped that I would get some practical tips for decluttering, and I did, but I also found something much more enlightening. It clicked during the 4th episode, when a family of four was working to control the clutter after downsizing from a large house to a 2-bedroom apartment. The crux of the episode was when it became clear that the mother was responsible for essentially all of the “stuff”, both physically, cognitively and emotionally, to the point where her adolescent children and husband would call her throughout the day because they couldn’t find anything. She had taken on the role and implicitly assumed the responsibility while working a full-time job outside the home. I won’t dive into a full analysis of the show (although there’s a good one on the show’s gender dynamics here). The invisible labor of womanhood and motherhood becomes visible.

Suddenly, I saw my impulse to reorganize our home and life in stark clarity. While I’m grateful that my husband is committed to gender equality in our marriage, we’re still fighting generations of inequality and implicit assumptions about men and women’s roles at home and in managing family life. So while some things are straightforward, ie, if I make dinner, he cleans up, and vice versa, other forms of emotional labor are not. Looking back, we can both see the impacts of very unequal emotional labor on each of our mothers. And the “stuff” is just one example. We both moved at least 10 times throughout our childhoods, sometimes internationally, and usually lived in rented housing. While my father was the “packing expert”, my mother managed the bulk of the organizing and cleaning and knowing where everything was, on top of knowing who needed what doctor/dentist/chiropractor appointment or freshly laundered uniform and what we were going to eat for dinner. And I subconsciously still assume that’s my role too. I’ve been able to keep up (mostly) with this invisible work while keeping up in medical school, although it’s gotten a lot harder since my son was born. I’m actually pretty good at managing a lot of this in my head.

But here’s the thing - I know it’s taking energy away from other areas where I want to be excellent, like being really present with my son when I’m with him, and developing into an excellent physician, and building the career that I actually want, rather than just slogging along on a one-size-fits-all career treadmill. I know the other members of my medical-student-mom squad feel it too. We’re constantly exhausted and we’re not even in residency yet. And while decluttering is helpful, it’s not the answer. Delegating is definitely part of the answer, but first I have to list out all of the things that I’m trying to do and then figure out how to delegate them. So keep an eye out for my household organizing/delegating app once I actually figure out how to do all of this. (I'm kidding - this is way beyond the scope of any app.)

No, I put this out there not because I’m expecting someone has a magic answer, but because I’m grappling. And I’m also grateful. I’m grateful for my wonderful mother and mother-in-law, who managed two large, chaotic households with so much love and way more patience than we ever deserved. They fell into bed at the end of every day exhausted for reasons they couldn’t even name. I’m so grateful to them for managing all of our “stuff”, both physical and emotional. And I hope to honor them by finding a way to both love and care for my own little family while letting go of some of those expectations and responsibilities. I hope to honor them by sharing some of the empathy and intuitiveness that I learned from them with my patients and colleagues too. And I’m grateful for the #momsquad that lets me vent without judgement about how hard all of this is, and the husband and toddler who love me just as I am.

Wednesday, February 20, 2019

Starting Young: A Bad Thing When It Comes to Body Images Issues

The other day, my 3 year old daughter said to me, "I'm feeling fat, so I need to go take a long walk."

Is this the start of myriad negative body image thoughts I will inevitably need to address during her life? Maybe she's just being a word sponge, but I can't believe she said this at her age. Where she learned or heard it, I have no idea. I just want to make sure I don't contribute in any way to it.

I've experienced my share of body image issues like most of us. When you have any unusual feature (in my case, it's being over 6 ft tall), your body becomes a point of commentary. And it can become part of your ego, regardless of whether that feature is considered positive or negative. Fortunately, comments made to me are usually complimentary. The other day, a woman in the gym locker room said to me, "Your legs are absolutely perfect. Amazing." Of note, this woman was herself tall, thin and beautiful. All I could do was laugh. I see my legs (and body, for that matter) as far from perfect - and that's ok.



Men vs. women... Although both sexes are prone to chasing perfection.
"Perfect" is a word we should stop using for many things. None of us can have a truly perfect body, be the perfect parent, the perfect spouse, the perfect doctor. There is no such thing as a perfect home, a perfect job, or a perfect anything. Someone's idea of perfect (in the case of my example, legs) is completely different than another person's vision. Maybe you value strength and thus enjoy the look of muscular legs, while another person desires very thin legs. You can soften the P word by saying "this is perfect for me", but I even have trouble with that. We're never done learning or improving. Why do we spend so much time comparing ourselves to other people and trying to measure up to some sort of perfection endpoint? Endpoints are for fixed mindsets.

Social media, which is a powerful tool for helping us as physicians reach a broad audience with our message, is also a huge conduit for comparison and the pursuit of perfection. And it's frighteningly problematic when it comes to our young girls, who tend to deeply value social inclusion and are very sensitive to shaming. I heard an interview with psychologist Jonathan Haidt, who recently cowrote the book The Coddling of the American Mind. He pointed out an alarming trend of increased depression and suicidality among young girls, which has suspiciously spiked with the ubiquity of social media.

I do love my own body, but I didn't always as a child. I remember wishing to look like "everyone else", to be shorter, smaller, etc. As an aging adult and physician who sees very broken bodies, I appreciate that my body's gotten me through some serious health challenges. I would never trade motherhood for a flat abdomen with no signs of a pregnancy. And I believe in striking a balance between accepting ourselves in the present moment while also trying to make improvements. However, my acceptance only came with age and life experience. I know it'll be difficult to instill these ideas into a young girl's concrete thinking.

What body image issues have you come across with your daughters, and how have you dealt with them? Do you let your girls have social media accounts? I'd love some positive solutions.


Friday, February 8, 2019

Bad Habits and how to (attempt) to kick them

When my mother went in to have her diagnostic laparotomy for metastatic disease, my father said that he knew everything was going to be okay because the surgeon had "beautiful, clean, well-kept hands."

Since that day 10 years ago, I have started to take more notice of hands.  As a doctor, the state of a patient's hands, and feet, can suggest underlying disease, hygiene, social situation. Manicured fingers, dirt under nails, dry skin, scabies rashes, diabetic ulcers, clubbed nails of hypoxia.

As I look down at my own hands, though, I'm constantly ashamed.

Confession:
I bite my nails. Not my nails, exactly, and not biting, technically. I pick my cuticles. It's gross, I know. Disgusting, I get it. It's an infection risk, a way for patients' MRSA, fungus, and ESBL infections to get inside. A risk for herpetic whitlow, paronychia. There is an official medical name: Onychophagia.  It looks unkempt. I KNOW.

I've tried getting regular manicures, but that gets a) expensive and b) time consuming. I tried moisturizing, creams, potions, and lotions and gels and ointments. I've read blogs. (link below). This repetitive behavior is SO HARD TO KICK.

Over time, we as individuals develop so many different habits and routines. The way we brush our teeth, which side of the bed we sleep on, which shoe or pant leg goes on first. What we eat for breakfast, which coffee we order, what we reach for when in need of comfort. Take a minute to pay attention to the things that make up your daily routine. We are creatures of habit.

Diet and lifestyle habits and routines are hard to change as well. With all the focus on "new year new you," the explosion of health and fitness "influencers" on Instagram, and the renewed energy that comes with a dedication to a new diet, eating plan, workout regimen, or health motivation, it should be easy. We have so many cheerleaders; however, ingrained habits require a lot of mental energy to change.

So I definitely have a little more compassion for patients when they tell me it is hard to take a new medication, change their eating habits, work out more. I can't seem to do it myself, honestly. (My 15 lbs- 4 years post baby- prove that) The constant reminder of my raw hands is the sign of a continuous struggle.

How do you motivate change? Have you found success with breaking a habit or changing your diet or lifestyle? What resources do you use, or guide your patients to?



Blogs I referenced:

https://www.glamour.com/story/how-to-stop-picking-your-cuticles-tips

Wednesday, February 6, 2019

Scheduling

The first inkling I had that scheduling was going to be rough as a resident parent started before Toddler was even born.

I still loathe the woman at the front desk at my OB office. Every time I waddled in, I would have the upcoming 3  months schedule in front of me and try to schedule as far out as possible. I was charming, flexible on clinic location, flexible about seeing different providers.  “How about Wednesday the 19th at 8:30 am?” “No? Well how about Thurs the 20th? At 1:20 pm?” “How about (insert particular hour) on (particular day)”. Eventually the receptionist snippily asked me to call the appointment line if it was going to take this long to pick a scheduled date. Note: there was no one else in line behind me. I fumed in the lobby as she clearly carried out a loud non-business call over her headset. Thank goodness for an uncomplicated pregnancy requiring infrequent visits and an office across the street from the hospital I work at.

Well child exams have been even more challenging to schedule as I’ve been trying to coordinate around when my child is actually well. I have the same conversations on the phone. No, Wednesday afternoons don’t regularly work for me, just the random one coming up. We have a great great great pediatrician - which means he’s always booked up. I had scored a rare 4:40 end of the day appt today, but alas - double ear infections and a cranky Toddler = a rescheduled appointment. At least today I’ve figured out how to schedule and reschedule online so I can least minimally annoy other people.

Also I’m getting a little anxious. We (gasp) decided to take a week long vacation this year but due to several medical reasons for my entire family... I’m down to 3.5 days off left before graduation. I used 2 in the last 2 weeks. I keep telling myself that hopefully the absolute worst thing that could happen is I make up a few days at the end of residency (as I already am doing) but still. We rolled the dice today and took Toddler to day care after a tearful sleepless night - but I haven’t gotten called yet and already got a photo of his grinning face so life can’t be too bad.

A nice reminder to myself to not get irritated over people constantly rescheduling with me in clinic. Who knows what they are all juggling. Often I can’t keep track of what I’m all juggling. Which reminds me I have to give tomorrow’s lunch lecture. Keep your fingers crossed as we will likely roll the dice again tomorrow.

Monday, January 28, 2019

Guilt and Determination

Quote of the week:

“Guilt is useless. Determination is important”.

One of my department faculty members is leading a day long seminar of Community Health.

She adds “If you really need guilt, keep it like a cat at home. Pet it every once in awhile, let it know you know it’s there - but when you leave the house, take determination with you.”

I love it. Even before Toddler came into the world, I told myself I would NOT be a guilty mom. I would logically know I was doing the best I could, logically know that I could not be in three places at once. I was going logic myself right out of guilt. Because we all know logic always wins.

I’ve been trying to be mindful when spending time with Toddler - no phones, no distracting screens, just him and me together. It makes me think of this post from Mrs Md PhD which is best characterized by the meme saying I WILL DO ALL THE THINGS WITH MY TODDLER!! (which is definitely due for a revisit if you haven’t seen it in awhile).


However since Toddler currently has the attention span of a small flea and likes to entertain himself a lot, a little too much mindfulness can send me off the deep end. So we’ll play legos together but a little podcast in the background goes a long way. Now that we’ve had a long awaited golden weekend together with minimal leaving-the-house plans, I was able to put that guilt aside for now.

One of my coresidents was feeling guilty lately about working her first week of nights while leaving her baby at home and I told her “you’re a better mom because you’re a doctor, and a better doctor because you’re a mom”. It took me awhile to realize that I really did mean it (at least about myself) and wasn’t just saying it to make her feel better. I appreciate the time I have at home without Toddler, but I also have a small glimspe now into why the nurses I work with who have 4 kids at home come to their busy shifts and sometimes consider it a “break”.

I also think guilt is ingrained into us in medical school. Guilt we didn’t present our patient perfectly. Guilt we missed that lab finding. I was with a second year medical student today, who kept saying “sorry” for things she couldn’t help - like the computer not loading or not having access to charts. It made me remember sitting with a co medical student on our internal medicine rotation watching her beg for an afternoon off for an appointment and constantly apologizing for having to leave. I’ve managed to cut out “I’m sorry” out of my vocabulary if it’s something I can’t help (unless expressing empathy for a patient). My feedback to her was to catch herself when she is going to say “I’m sorry”, see if it’s something she could have actually done anything about, and cut it if she can’t.

I’m sure there are still going to be times I feel guilty, especially if we have another day care drop off melt down tomorrow, but I’m going to do my best to pat Guilt on the head and leave with determination in hand.

Kicks

Monday, January 21, 2019

Looking how to complete the medical equivalent of #squadgoals


As a resident, I rotate through a number of different departments and different hospital sites. This past month (or last month, because I'm late on posting this), I rotated through the trauma service.

On a string of nights, I met another strong, powerful, kick butt mother in medicine. A senior surgery resident on another surgical service, she was not my direct senior; but as we both set up headquarters in the trauma bay, we had the work equivalent of an all night sleepover, q3, for about 2 weeks.

It was so much fun. Being a resident who is also a mom is pretty lonely at times. I'm not free for most brunches, I don't party on weekends, I can't commit to an 8 pm weekly spin class. While I get along with most people on shift,  it has been difficult to connect out of work- with both men an women residents alike.

How do you bridge that gap? Part of me likes having that separation of work life and home life. But  recently, when a resident - who I always laugh with on shift and love working with- got married, it stung that I wasn't invited.  I offered to cover her call, though.

So I will continue to look out for members of the club. Give a head nod to the pregnant resident on the admitting team, look out for the one with pictures of her kids on her phone background. It's nice to be recognized and it's nice to be part of a larger team.





Sunday, January 13, 2019

When it's time to get unstuck

Have you been feeling stuck? What are you going to do to get unstuck? Maybe start with your sock drawer? Or start with a vision board for your practice? Or start with a date night with your partner or a girls' night out with your friends. Or start with a breath. Whatever you do, just start!

For the last few years since finishing residency, I have been grappling with many things. After my disappointing first job as an academic pediatrician (my "dream job" I thought), and my foray into private practice I realized that the system of medicine many of us practice in, corporate medicine with the primary goal of seeing enough patients in the day, simply didn't fit with the what fuels my heart.

I spent two years during my American Academy of Pediatrics Leadership Innovation Fostering Education Fellowship researching physician wellness and in particular how systems and practices must incorporate wellness and burn out prevention at all levels. It is not enough to tell physicians to meditate if they are being "strongly encouraged" to see more and more patients, have burgeoning administrative tasks (click this meaningful use button), have mountains of debt, or are in jobs that they hate because of loan forgiveness, have less and less control over their schedules, and less time to make meaningful relationships with their patients. A mindfulness seminar won't cut it. Physicians everywhere are saying enough! It's to much! Record numbers of our colleagues are walking away from medicine or are joining the ranks of the hospitalists and specialists. What happens to our system when there are more hospitals, urgent cares, and intensive care units than quality, sustainable primary care practices? What will continue to happen when emergency rooms and surgical suites continue to be more lucrative than wellness centers and small, high quality private practices? Does it mean people will be allowed to get sicker and sicker? Does it mean that large hospital systems will continue to invest less into primary care and more into expanding their Emergency Rooms? Money talks, right?

This year I will be undertaking some exciting new endeavors. To try to get back to what inspired the premedical student who had all of the time in the world to sit with my patients, to commune with them, to build with them. We see it all around us. Patients who can afford it are flocking to naturopaths and integrative medicine doctors. The overwhelming response is that those providers listen. They have the time. So I have to make the time.

I have been hustling and working, but I still felt stuck. Stuck in fear. Stuck in a laundry list of things to do. Stuck in the what ifs. Stuck. So again, I use the tools that I have and start to research solutions. I have been listening to a lot of podcasts about following your dreams and reading books about decluttering and re-envisioning your life (see the list below). I even watched Marie Kondo's Tidying on Netflix. I saw the piles of clothes folks had and thought "yuck! How could things get so bad?" And then I did this while my boys are away:


(clothes stored in my closet, attic, and drawers - don't judge me until you try it! Very eye-opening!)

It's no wonder I feel stuck. I have been holding on to so much. I still have clothes from my first attending job and from my corporate job that I know I will never wear again. Letting go of them causes so many mixed emotions. Failure. Courage. Pride. Anxiety. Commitment.

It's time to get unstuck. The piles and piles of donations, maternity clothes to pass down, and work clothes to pass on won't unseat themselves. No one is coming to save me. I am saving myself. Starting right here. In this moment, again. And I will do it again and again PRN (as needed for those who don't abbreviate on their prescriptions). One day at a time.


Above references mentioned:

Podcasts:

  • Dreams in Drive
  • Side Hustle Pro
  • Therapy for Black Girls
Books:

  • Marie Kondo's "The Life Changing Magic of Tidying Up"
  • Dr. Dike Drummond's "Stop Physician Burnout: what to do when working harder isn't working?"
Blogs:

Netflix shows:

  • Tidying Up with Marie Kondo 

Thursday, January 10, 2019

Breaking through the emotional barrier


We have the same birthday, she and I. We were born worlds apart, both geographically and culturally, but on the same day of the same month in the same year. I noticed her birth date, right there on the front page of her daughter’s, my patient’s, medical chart. Her daughter, who should have been a princess. In a family full of men and boys, sons and nephews, the baby was the first girl to be born in over 40 years. The family prepared for her birth, overjoyed, buying frilly dresses and pink bedspreads and dolls. But it was not to be. Mother was stricken with intrapartum hemorrhage and baby was born with anoxic brain injury, doomed to be neurologically devastated.

And that’s not even the worst part.

She tells me that she and her husband sometimes imagine what it would be like if her daughter, now turning one, were born healthy. They can almost hear her say “mama” and “dada”, can almost feel her hugs as she runs, laughing, into their arms. They wonder if she would be crawling now, walking now, what food she would like best, and if her older brother would share his toys with her. They mourn what could have been, what should have been.

That’s not the worst part either.

In their home country, they were told to leave her to die. They were told not to pursue medical care, that God would take care of “the situation.” And that’s when they packed their bags. They ravaged through bureaucratic red tape and procured visas. They left it all, their supportive family, their grand estate, and moved to a small apartment in the United States so they could get medical care for their daughter in the first world. In their home country, they were royalty. And here they work menial jobs to make ends meet. She works at a local supermarket, bagging groceries. One day, she tells me, a customer was checking out groceries with her own daughter, who was particularly rambunctious. The customer was frazzled, stressed, in a rush, and frustrated with her daughter. The customer turned to the woman, this grocery bagger, this almost-but-not-quite-bereaved immigrant mother and said to her, “She’s driving my crazy. Do you want her? Just take her.”

And that was the worst part.

Does she want her? Well, not her exactly, but yes, of course she craves a normal, healthy daughter. What a horrible thing to hear. What a horrible thing to say. It’s not even that the customer was trying to be mean; it’s not human cruelty. It’s the cruelty of the universe, the cosmic unfairness of it all, coupled with human indifference and sarcasm, that combine together to create a vortex of heartbreaking tragedy.

I take care of children like this every day. Children with chronic illness, children with neurologic devastation due to the unfortunate hand that was dealt to them: prematurity, trauma, genetic disease. In order to survive as doctors, there must be an emotional barrier. We can be empathetic, but we cannot get too close emotionally, otherwise we cannot function. But this one hit me hard. Maybe it’s the fact that we have the same birthday. Or maybe it’s because I, too, suffered intrapartum hemorrhage, but because it was expected and planned for, the baby and I did incredibly well. Or maybe it has to do with the fact that I am freshly back from maternity leave after recovering from said complicated delivery and I am physically and emotionally exhausted. This one broke through the emotional barrier and catapulted me from the land of empathy to the state of feeling.

I want to say to her: I feel you. I feel your pain and your heartbreak and you are not alone. Let me bear some of it for you so you can take a breath. Right now, as the discharge papers are being printed and you are collecting your things, let me shoulder some of this pain for you. I don’t say it. Maybe I should but I don’t. I squeeze her hand and wish her well and tell her that her daughter is lucky to have her. I thank her for the opportunity to take care of her daughter, and I say goodbye.

Tuesday, January 1, 2019

New Year Goals

2018 was intense, harried, and a blur. There were highlights, like our first international trip to Italy in June (amazing, loved every minute, especially hiking through Cinque Terre and going on a timed family scavenger hunt through the streets of Florence), but there were also times that were just so busy that we were just trying to get through the week and not forget anything big (like that First Communion parents' night meeting that I totally forgot).

The busyness was entirely self-inflicted, a combination of too many kid activities, daughter applying to high schools (yes, it's a thing - a very stressful and energy-sucking thing), did I mention too many kid activities? There's three of them and we try to make sure they all get enriching experiences that they are interested in, but it's reached a comic/insane level if I do say so myself. Soccer alone.

Upon reflection during this sedate winter break, I've decided that I'd like to work on some life goals for 2019 for our family and home.

  • More time with friends. We once tried to have friends over once a month which was awesome until it petered out. I think this is important for all of us and also important to our house in terms of general upkeep. We are resurrecting Guests of the Month and thinking of our first invites!
  • De-cluttering. Our next door neighbors have the same exact house as we do but the mirror image. They had a holiday party which we attended last week and each time I'm in there, I marvel at their lack of clutter. They have NONE. Now I know it's a party and I'm sure they got it party-ready, but they are naturally immaculate (have 2 older kids) and spare. I came home from the party ready to donate 1/3 of the items in our house. We started with the Great Clean Out by having a family organization event of our basement storage room. The storage room has items like Rollerblades circa 1992, a small couch, and 5,395 other items strewn about in no particular order. It's level 2 Hoarders, Buried Alive. All 5 of us were down there, throwing things out, cleaning up, organizing, donating, and it looks amazing! No longer an embarrassment when the plumber needs to go in there! It felt good and didn't take too long. We also unearthed some forgotten treasures like my medical school commencement program and a birthday letter from a college friend. 
  • Developing kid grit. Husband and I have decided that at least some of our kids lack grit and tend to give up easily. While watching our two boys, 7 and 10, on an unseasonably beautiful day during this break, I decided we needed to go on a Mom and Sons Run to enjoy the day and get some exercise. After the complaining and realization that I was set about this plan, we all ventured out to do a neighborhood run - just 1 mile! Now, we've all run a mile before- they've all run a 5K - so a mile is nothing right? Well, during that 1 mile, there were 40 stops, crying (someone fell), pushing (in play but still), a side cramp, and so much walking--I had to pause my activity tracker twice until we could continue. It was like the Bad News Bears Go On a Short Run. I told Husband and we decided there would be a repeat Family Run the next day as part of Grit Bootcamp. It was actually pretty fun. The 5 of us ran 1.25 miles with minimal stops and the 7 year old said, "We ran faster, longer, and it wasn't as bad!" We want to teach them they can get through discomfort and to be mentally tough too. More Family Runs to come!
  • Mangeable kid activities. I want to include a question mark here since I'm half-hearted about this goal. I think 7 soccer teams was definitely over the top last fall, but I also want them to have time to pursue their interests, develop themselves, etc etc. I guess my goal is to be more conscious of our whole family schedule and to make sure everyone has some down time. Spring means only 4 soccer teams so that's a start! 
  • Be more connected to others. Beyond having guests over, I want to reconnect more with friends and make time for that. I want to carve out more time to be connected with my husband. And continue to have great family unit time. I think this means committing to the bullet point above because connecting takes time and time is of short order around here.
Any one else have goals they hope to tackle in 2019? I figure writing them down makes us more accountable so feel free to share in a public declaration. :)