Showing posts with label Emeducatormom. Show all posts
Showing posts with label Emeducatormom. Show all posts

Tuesday, February 14, 2017

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.



Tuesday, April 5, 2016

A Year of Change, and a New Sandwich

I rang in 2016 with visions of change. Change for the better. Growth. Development.

Well, 2016 is going to be full of changes alright. I’m trying to finalize my divorce, considering joining the dating world again, finding new feet after being partnered for such a long time. So, why does the tenor of this post not hold all the hope and light and optimism it should? My move mostly across the country for medical school, residency and career was not coincidental. It was therapeutic. Right now, my self created bubble is being tempered by reality.

I knew I’d be the child to take care of my parents. Neither of them have planned for golden years. Both have made poor financial decisions. I’ve tried to learn from their mistakes. Many of the decisions I’ve made in my life are a direct result of trying to exactly the opposite of what either of them have done. I’m the only child between them. Their other children, my half-siblings, are in no position to help.

I did not estimate that by trying to learn from their mistakes and deliberately making other decisions, I’d put myself in the supreme position to catch them when they fell. Of course, I love them deeply, fully. They are my parents. They supported me emotionally through my journey to get here, they brought me life, they gave me the genes to create the synapses that allow me to make the decisions I make which hopefully translate into quality patient care and contribute positively to the world. They have loved me, advised me, chastised me, praised me. They were fully responsible for me for seventeen years of my life… that means I’m responsible for them, right? Not now, right?

My dad has been diabetic for about twenty plus years now. It ran in his family. He was overweight. He knew it was coming. He ignored the polydipsia, polyuria, fatigue, headaches, weight loss.  When he finally presented to his physician with the aforementioned constellation of symptoms, they confirmed the diagnosis. His response: Eat a gallon of ice cream and drink a two-liter bottle of Coke. He tows his own line and nothing is going to happen unless he’s ready for it to happen. No one knows his diabetes better than he does. He knows how it “feels” to be 245. He also knows how it “feels” to be 120. He’s got this.

Visited for my youngest brother’s graduation from high school. I was in residency at the time. That’s the first time I saw my dad have a low. Pale, diaphoretic, eyes glazed over, tremulous, almost myoclonic jerks. Orange juice spilled from the corners of his mouth as my adrenaline coursed through my veins, heart pounding. He finally came around. My ex-step-mother rolled her eyes, sighed in disgust. My brother sighed in relief. I was stunned. They had seen this before. They were well versed in dad, the brittle diabetic. I went back to residency and my life and put my dad’s hypoglycemic episode in a compartment. I went back to my other life. You might recall my compensatory compartmentalization if you read my first post,  The End... and the Beginning. 

More recently, I visited my dad’s town for a conference, took the little one and my mom (my dad’s first ex-wife) came to visit as well so as to spend time with the grand-baby. We all stayed at my dad’s house. I wake up around 3am to my mother screaming with surprise as my once again diaphoretic, hypoglycemic father, confusedly tried to crawl into bed with her. They’ve been divorced since I was two. She’s got not medical background, has no idea what’s going on. Here’s my internal monologue over the next 5 to 10 minutes:

I know he’s low. Don’t freak out or your mom’s going to freak out. Give her a task. Tell her to find his glucometer. She doesn’t know what that is. Tell her to find his shaving kit. There’s a little blue plastic machine inside. And a plastic container with strips. Tell her to look for the glucose paste. God, I hope he doesn’t wake the kid up. I’ve got no idea where his glucose paste is or whether he even has glucose paste. What’s in the fridge? Kiddo’s juice boxes. Great. Sit down dad. Sit down. Oh, super, your legs don’t work and you won’t cooperate. This is excellent. Drink the juice box. Seriously, Dad? Just swallow.Crawl into bed with mom and scare the shit out of her? Thanks for that. How much did you drink last night? How much sugar is in one of these organic reduced sugar things? How many is this going to take? What else is in the fridge? How much insulin did he take? He’s not drinking it fast enough. Shit. I’m an ER doc and I can’t fix my dad. What in the absolute fuck?!? What’s his renal function? More juice, Dad. Tell Mom to get a chair. Put it behind him. We have to make him sit so he won’t fall. Ok, Dad, you’re not sitting down… I’ll sweep the leg, just like Karate Kid. Great, now you’re sitting. This is taking too long. He’s not turning around fast enough. He’s not swallowing. He’s going to seize. Fuck it. Tell Mom to call 9-1-1. Tell them you have a diabetic who is hypoglycemic and you need help.

The paramedics arrived and by then, my dad was starting to come around. “I know exactly what happened,” he said. “I took my Humalog and forgot to have a snack. No big deal. I’m all set. No, I don’t need to go to the hospital.” Sure Dad. You know exactly what happened.

One of my dad's best friends asked me for my number that visit. He said "just in case I need to call you for something." He said there'd been times he'd supposed to meet my dad for golf and he wouldn't show. Then he'd come to my dad's house to find him in a hypoglycemic stupor, "sweaty, turning the lights on and off, not knowing where he was or what he was doing." So, it seemed this was not an infrequent occurrence. 

Ultimately, I didn’t think I’d be taking care of one of them now. My father who’s made some poor decisions has run out of options and was in financial dire straits. My dad was going to be homeless. He came to visit for my kiddo’s 4th birthday. He’s not the picture of health. He’s stubborn and manages his diabetes between 6 packs of beer, packs of cigarettes and takeout food, often, unintentionally double dosing his insulin, or so he recalls when he comes out of a hypoglycemic episode. He finds himself in a diaphoretic, near seizure stupor which until this last year, I was mostly, blissfully unaware. Sure, I’d been to visit and he might have a low, scare the crap out of me, lead me to feel woefully ineffective as a physician, then he’d confabulate that of course he knew exactly what happened.


He asked if he can come live with my little one and I. I took a deep breath, clenched my jaw, said “of course.” He's my dad. I've got to take care of him. That's my duty as his daughter, right?

My dad's been alone for a long time. He's lived the bachelor life for a long time... probably close to 15 years or so. He doesn't take good care of himself. He doesn't eat properly. He doesn't exercise. I had this vision when I invited him to come live with us that magically some switch would flip and he'd suddenly be inspired to focus on his health and well being. I envisioned he'd start eating properly, start exercising, maybe catch up with old friends who are local, find a job, find his spirit. 

He's now been living with me for about three weeks. He's had at least 3 hypoglycemic episodes so far. I say at least because those are the one's I've witnessed. He drinks too much. Thankfully, he's not a mean drunk, but I do believe he is an alcoholic. I have observed his behavior, listened to his conversations with me, watched his interactions with my kiddo and I wonder if he's actually developing some dementia of sorts. Not sure if it's from repeated hypoglycemic episodes, some sort of microangiopathy due to his health, or if he's showing signs of Wernicke-Korsakoff. There's definitely some confabulation going on.

What I believe I've learned in this short time is that I had no clue what I was getting myself into. So many of his behaviors and attitudes and coping strategies mirror those of my ex, which makes this whole thing even more challenging to swallow. I do know that I cannot be his doctor, his therapist or his best friend. I cannot control his behavior or effect the changes I believe need to be made. He is likely clinically depressed, though this is clearly complicated by his alcohol use. It was naive of me to think by some magic that he'd do a 180 by coming to live with us. I'm trying to encourage him to seek the care he needs both for his psyche and for his health. I can lead the horse to water, but I cannot make him drink... Why can't I make him drink!?!?

Permanent cohabitation is not going to be an option for me and my well-being. I have to make sure that my little one and I are taken care of and that my child's environment is safe and stable. Friends have suggested that I impose rules upon him with the threat of kicking him out. Trouble with that is I won't kick him out. I'm not going to put my father on the street. I'd rather find a way to get him his own living space so he does impinge on mine. How does one make rules for their own parent? 

Sunday, November 8, 2015

The End… and the Beginning

When I was first queried about writing, specifically for a blog like this, I was excited, nervous, surprised… would other mothers in medicine actually want to read what I have to say? Would this be an opportunity for me to reflect upon my own clinical and academic practice? Would this enable me to grow as a physician mom? 

Like many things I’m sure you all can relate to, this idea fell to the back burner, simmering. I now find myself at a critical point in which the stew that is my professional and personal life are bubbling, coming to a boil and I find this the opportune moment to jump in. This comes on the heels of a gentle reminder from KC, for which I am thankful. 

I am approaching the final stages of divorce. In order to proceed with finalization, I have been required to attend parenting classes. I won’t go into just how asinine I thought this was given he has no requirement to attend said classes. Nevertheless, I showed up with intent to learn as much as I could that I’ve not already discovered through trial and error in the co-parenting adventure. I was surprised that they started with Elisabeth Kubler-Ross and the stages of grief. I took that with a big arms across the chest eye roll, then softened a bit as I thought more about each stage and the fact that this transition does in fact mark a loss… I’ve since considered my own transition through the stages and thought back on the years we were together. 

It’s taken nearly three years. I asked him to leave almost three years ago with our eleven month old son on my hip, seething with anger and pain. Eight years of emotional roller coasters. Eight years of infidelity. Eight years of me not acknowledging my own value. In that moment, that decision, I chose myself and my child. I chose to remove myself from a relationship and marriage which was so far removed from anything I wanted to model for my progeny. I had finally come to the complete realization that my husband would not every remain faithful and tend to his responsibility and commitment to me as a life partner. I did not want my little one to watch and live in an environment where a person whom is purported to be loved is treated that way. I have come to terms with the fact that I have zero control of half of this equation (my ex), however I have full control of my own actions, behaviors and decisions. 

So, if you will, walk through the stages with me. 

DENIAL 

Every single time I found out about another indiscretion of infidelity, I refused to believe it or give it any power. I denied how devastating his actions and betrayal had been. I denied that he’d made a seemingly meaningful connection with anyone in this world other than me. I denied that he’d violated my trust. I denied that I deserved to be treated with respect, dignity, love and commitment. I denied my value. I denied my intelligence. I denied my sex appeal. I denied everything and assumed it was my fault. I stuffed my emotions and hurt into a little box and told myself he’d be better. I denied my visceral sense that his behavior would never change. I denied my better sense. I denied my friends’ pleas to remove him from my life, over and over again. 

ANGER 

This emotion is incredibly primal for me, particularly in regard to this situation. My instinctual, somatic response was long buried due to a longstanding practice of compartmentalization. The trouble with compartmentalization is that it is both protective and destructive. I put those sad, hurtful, scary, heart wrenching things in a box, I lock each box, then I dissociated from those feelings with the hope to never, ever have to feel those terrible feelings again. I felt comfortable, or at least I felt that I was well enough in control of my life to go about my day to day. Then there come times when I’ve run out of capacity in my emotional compartments and for me, that’s usually when I feel least in control of this primal behavior. On the surface, I perceive myself to be fairly calm, cool and collected. When my fully stuffed compartments start to overload, the anger floods over me, forcing my hand to process what’s in those boxes. This is also the crux of that inherent destructive nature of compartmentalization as well. 

When this happens, my transition to anger is a painfully exhausting one. Each of us experiences it differently, but I can tell you how it feels for me. I develop an ache in my chest, then my heart rate quickens, blood rushes to my head, my jaw clenches, my nostrils flare, my posture becomes more erect and inevitably, my left eyebrow raises. My hair stands on end, my pupils dilate and I coil into position to strike. If it happens too quickly, it blends with the hurt and tears well up alongside my venomous words. At the same time, the sense of power that comes with anger is intoxicating. If it happens more slowly, I can calculate my response, choose my words and actions in a much more strategic way. I feel much more in control and strong. It’s a delicate balance, however, between the primal emotion and the controlled response. My ex, whether intentionally or not, can always find ways of awakening the beast within me. I’m still learning my own triggers and how best to turn each experience into something productive rather than destructive, with particular focus on self preservation. That, however, is for another conversation. 

BARGAINING 

Anger is powerful, but it’s also energy intensive and exhausting. That adrenaline rush only lasts for so long and in general, I’m a big softie. So, let’s get to part of my own challenges with him. The mind is strong, the woman is strong, the flesh is weak. I rationalized that if I reclaimed him, I somehow won. Then I’d turn the blame onto myself. I’d make lists of the things I was or was not doing that must have somehow had an impact on his behavior. If only I wasn’t studying so much, if only I spoke another language, if only I were more exotic, if only I wore more makeup more often, if only I were thinner, if only I were funnier, if only: insert any markedly self-deprecating phrase, he wouldn’t have strayed. I’d consider what I could change about myself to keep him from doing it again, maybe if I were more shapely, or if I colored my hair, or if I wore more makeup, or if I spoke another language, or if I had perfect skin, or if I had perfectly manicured fingers and toes. I was just certain that I could do something to inspire change in him, then in my depression, he’d feed into the bargaining and do bargaining of his own: “I’ll delete her number, I won’t work with her anymore, I’ll delete that email account, I’ll go to counseling, I love you, not her, I don’t know what’s wrong with me.” On and on. Of course, this spoke to the caretaker in me as well. There must be something wrong with him and I can help him! What a poorly rationalized thought which cost me the better part of a decade and emotional scars which will eventually heal, but not disappear. 

DEPRESSION 

I spent eight years ping ponging between denial, anger, bargaining and depression. It happened so frequently that it just became the norm and an expectation. It was just a matter of time until it would happen again, then pieces of my heart would chip away, I’d become furious, buried in anger and wanting to lash out. When he, the person in my life to whom I’d given everything I could possibly think of giving betrayed my trust and discarded me as if I was worthless, I became worthless. I devalued myself. My life lost it’s color. Everything was grey. Tears ran until there were no more tears. The ache in my chest became colder, darker, then numb. I anesthetized and dissociated myself from the situation, from our life together. I ached for connection. I ached to be desirable. I drank, a lot. 

The most marked period of depression in all of this was not actually after I finally asked him to leave. It was when he told me he didn’t love me and wanted a divorce. I packed my bags. I had no idea where I was going. I searched frantically on Craigslist and found a furnished studio which fit into my budget. It was close to the subway. It was close to a grocery store. The grocery store had wine. I could get to work. I could get food, not that I had an appetite. I became a hermit, a one to two bottle of wine per night hermit. One day I woke up and realized that this was not at all in my best interests and pulled back on the alcohol, found a 10 mile race to train for (I’d never run that far in my life) and redirected my energy. Slowly, the depression lifted which softened my heart and he came back into the picture, again. In my softened state, I let him back in, of course, but that’s a story for another time. 

ACCEPTANCE 

This may sound strange to you, but the last time I let him back in, I knew it wasn’t going to work. I had decided that he was not going to change, but I was going to give it one more go. You may be thinking to yourself, “WHAT?!?! Is she crazy?” Maybe, a little bit. We all have our own pathology and demons and this was my path to take. My decision to let him back into my life and my heart was complicated, as these situations often are. As was our cycle, there was wooing and there was romance and of course there was sex. Then one day I realized I was incredibly sensitive emotionally, my breasts were swollen and sore, and GASP! I was late. I immediately ran to the drugstore, bought a pregnancy test, walked to nearest coffee shop and went into their bathroom, and melted into the bathroom stall as two pink lines showed up. Did I forget to mention that I was tapped as a chief resident for the next academic year just one week prior??? 

He never wanted to have children. I could just not tell him. I could cut him out of my life forever. I’d always wanted to be a doctor and I’d always wanted to be a mom. How in the world am I going to do this alone? I knew he was going to completely flip out. It would be so much easier to not include him. Alas, that wasn’t the right thing to do. So I told him. He was livid. “How could this happen?” Ummmmmm, I know you’re not a doctor, but seriously? Remember all those times I reminded you that I wasn’t on birth control anymore because I didn’t think it was necessary given I was alone in a studio apartment drinking my life away and maintaining solitary confinement? Well, we had many conversations about termination, so much so that I went to Planned Parenthood for a preliminary appointment. This was followed by a call in tears to my best friend in the entire world about how there was no way I could do this alone and that I couldn’t count on him for anything, so wouldn’t this just be easier. Thankfully, she talked me off of the ledge. She knew that I wanted to be a mother more than anything and that all of the excuses I was coming up with were silly in the grand scheme of things. I’m a strong woman and I thankfully have a wonderful circle of friends and I would figure it out. I would be ok. We (my kiddo and I, at least), would be ok. 

Then it became clear that he was still involved with tomfoolery with one of the many women from his past. She got involved and there were text messages and emails. I have to say, the level of class demonstrated by all parties is fodder for another time. Ultimately, he cut ties with her, promised to go to therapy for his “sex addiction” read “narcissism.” By the time I was eight months pregnant, he’d demonstrated sufficient amounts of commitment that I finally moved back in and we planned for the arrival of our baby. 

I knew it wasn’t going to work. I. Knew. It. Was. Not. Going. To. Work. I felt compelled to give it one last go for the sake of our little one. I also had an inner dialogue that was determined to figure out how to at least be a parent with this man. We made a small person. I’m stuck with him no matter what happens between us and our relationship. I have to tell my child when they’ve grown bigger and understand more of the world that I did try to make things work. I also had to give my ex the opportunity to be a father, though he never thought he wanted to do that. I wanted to be able to look into the eyes of my pride and joy when they ask why mommy and daddy aren’t together and speak frankly, honestly, that I did everything in my power to make things work… and they just didn’t. I want to say that we both love our child and have our child’s best interests in mind and want them to grow up happy and healthy. 

So, when I was in the midst of my first year as an attending, spending a fair bit of time as a solo parent with our newborn given my husband’s work related travel, and my little was 9 months old and I got a phone call from my father-in-law. He was nearly hysterical as my mother-in-law had just had a CT scan with a mass and mets EVERYWHERE. I knew what this meant. My father-in-law had an inkling, but not a full understanding. He’d tried to call my husband. No answer. I tried to call my husband. No answer. Text. No answer. Another phone call. No answer. I called the hotel where he was supposed to be staying for his work related conference. “I’m sorry, ma’am, there’s no one by that name in this hotel.” Call to his boss. “I don’t think he’s checked in to the hotel yet.” After trying to reach my husband on an emergent basis for two and a half hours, he finally called back. How do you deliver bad news to the love of your life after you’ve been unable to contact them for a prolonged period of time? You don’t ask too many questions about where they were, who they were with and what they were doing… after all, their mom is dying and they don’t even know it. You take a deep breath, tell them you have some difficult news and follow that with as much promise of support as you can. I told him they’d found a mass, it was very concerning for widespread cancer and we needed to figure out how to get him home and us on a plane to see her. I called my colleagues, got shifts covered, booked our flight, headed across the country. 

My husband stayed. I came back to work and essentially be a single parent. I facilitated conference calls with specialists, primary care physicians, hospice providers, and my husband, father-in-law, brother-in-law. I was the tele consult 24 hours a day, while caring for our infant, managing a nanny who left a bit to be desired, managing my board exams and finding my way as a new attending. My mother-in-law didn’t want treatment. She wanted quality of life. Her sons and her husband could not fathom this. My father-in-law understood her desire, but his heart was broken. He was watching his love slip away right in front of his eyes, in his own home. The boys on the other hand were going through their own grief process. My husband was distant. I expected this. I figured it was his process. At the same time, just hours after we celebrated her life in a remembrance ceremony after her death, the text message that came from his paramour, while not unexpected, her timing was audacious. “I think he’s lying to us both. I hope he comes clean with you.” 

That was THE moment of acceptance. I knew it would come. I just needed to go through the whole process. That was the moment our marriage and relationship was over. Now, don’t get me wrong, there certainly followed moments of depression and anger and a sense of loss, but there was no bargaining and there was absolutely no turning back. That was the point of no return. I am worth more than this and my child deserves to learn that I will not accept being treated this way. My kiddo deserves at least one parent who strives to demonstrate the value of meaningful and lasting relationships built on communication, openness and trust. I refuse to accept that life anymore and am moving on with my new life and my little one.

Here's to new beginnings.