Showing posts with label FreshMD. Show all posts
Showing posts with label FreshMD. Show all posts

Wednesday, January 21, 2015

Guest post: Fewer patients, more friends

On the face of it, a day at the clinic seems very social. I see patients, one after the other, from nine until four, with a break for lunch. Most of my patients I've known for a while now. I get caught up on their their lives - school, family, work. "How are your spirits these days?" I ask almost every time, patting my right hand over my heart, using the most effective cross-cultural mood elicitor I know.  It doesn't get much more personal than this. It's just me and the patient, our knees almost touching, in a small exam room with the door closed and an interpreter behind my left shoulder.

I leave work after a day of this, drive the five minutes to pick up my three-year-old from preschool, and begin the commute home to Deep Cove. Suddenly I'm ravenous. I ask Ilia what's left in her lunch box and she hands me some carrot sticks and cubes of cheddar from the back seat. Ten minutes later, around Grandview and Nanaimo, I bottom out, utterly exhausted. The idea of having to shepherd four kids through meal time and bedtime chores after this feels impossible.

If Pete's not away on business, I come home to sous-vide salmon and curried cauliflower, and we divide up the after-dinner work. If he's traveling, we eat the lasagna my thirteen-year-old put in the oven when the big kids came home from school. Then I oversee homework and lunch making, brushing teeth and laying out tomorrow's school uniforms.

I cut corners. I pick the bedtime book with one sentence per page. I move up the bedtimes of the kids too young to notice. I want the noise to stop, even the singing. They're getting shortchanged, I think, but  I'll make it up to them later in the week.

Where I live. And why I live here. © Martina Scholtens. Deep Cove, BC
For years, I've seen patients Monday, Tuesday and Friday. Mid-week I'm home with my youngest, grateful that Deep Cove is off the beaten path. We can't see our neighbours from our place. Looking up from the laptop now, I see a stand of waving cedars, the gunmetal grey winter waters of Indian Arm, and the dark bulk of Belcarra rising from the opposite shore. The solitude is perfect. No play dates, thanks. No community centres or meeting up for lunch, either. I might be up for something on the weekend, but it'll take until Saturday evening to recover from Friday's walk-in clinic.  I need a respite from human contact, and I prefer as much solitary time outside the clinic as four kids will give me.

I forget, though, that seeing patients isn't at all a substitute for catching up with friends over drinks.  At the clinic, the topics of conversation, the confidences, the complaints - they're all one-sided. It often strikes me that family physicians are professional friends: non-judgmental, accessible, reliable, skilled listeners and excellent secret-keepers. There's pleasure in seeing patients, but really, it's business.

If you had told me that I'd have four kids and eight hundred patients, and feel lonely, I'd never have believed you. But my work drains me to the point that all of my spare time is spent trying to recuperate. Pete would love to have people over more, and vacation with other families. I always imagined a noisy, boisterous home with friends and family coming and going, but with my work commitments, I don't have the psychological reserves to make it happen.

Then I had an epiphany. Clinical work exhausts me with the people lineup, and my social life is extremely thin because I need stretches of alone time to recharge from work. I ought to reverse this. I need to implement more solitary time at work, and more people-time in after hours.

I've started on this. In October I gave up my Friday clinic. I've worked Fridays since I finished residency in 2003. Now I finish the week with administrative work and other projects instead, alone in my organization's secret library. Just me, a row of computers with access to our clinic's EMR, shelves of journals on paediatric nutrition, and a yellowing poster on Boolean operators. I can do this very happily for much of the day, and still have the energy to go out with Pete at night. It's been life changing.

I knew from residency that I couldn't see forty patients a day, five days a week. I find it hard to do half that. Maybe it's that my patient demographic, refugees with trauma histories and multiple barriers to care, are particularly challenging. Or maybe it's the demands of four kids. Maybe our clinic needs to use a different model of care. Maybe an office with some natural light and a view of the North Shore Mountains would help. There are probably other changes I could make to bolster my psychological fortitude and soldier on, even thrive, in this setting. But for now, I've reduced my work hours devoted to direct patient care.

Three months in, and no regrets. Before, I felt like I spent everything at the office. Now I've got this feeling of having a bit of pocket money. There's the promising jingle of spare change.


-Martina Scholtens, cross-posted at www.freshmd.com

Monday, June 16, 2014

Guest post: Two points for knowing what you don't know

I’m driving the kids home from school, winding along Dollarton with afternoon sun glinting off Burrard Inlet, and Saskia’s telling me about the Gauss Mathematics Contest she wrote that morning.

“I left one question blank,” she begins. It’s a confession: a perfect score is off the table. She doesn’t add up test scores, she works back from 100. She goes on, “But I did that because of how the scoring system worked. You got six points for a right answer, two points if you left it blank, and zero points for a wrong answer. I wasn’t sure about the last question, so I just left it.”

I make her repeat that, making sure I have it right, because I know I’ll be chewing on this for days.

They were rewarded for leaving alone what they didn’t know.
Making a wild stab at an answer was worth less than no response at all.
For once, it wasn’t about doing one’s best, but about acknowledging one’s limitations.

Screen Shot 2014-06-10 at 11.00.42 AM

* * * * * * *

I was assigned to a family practice when I began residency in 2000, for several 4-week blocks over the two year program, and callback every Thursday afternoon. It was an established practice on Broadway and Granville, and a good group of doctors, but I dreaded seeing the patients, mostly well-heeled reproductive aged women.

Making a diagnosis and treatment plan on my surgery rotation, or in the emergency room, wasn't a problem, but these women kept presenting with issues that weren’t in any textbook. One couldn’t interpret her baby’s cries; another needed advice on dealing with strangers’ remarks on her child’s birthmark; the next had discovered her teenage son’s porn collection. Working at this family practice was by far my least favourite rotation, and I was doing a family medicine residency. That worried me.

My preceptor and her partners took the entire clinic out for Christmas lunch that first year, between morning and afternoon clinics packed with patients wanting to be seen before the holidays. I remember Sarah pausing during the meal and saying to me congenially, “You know when we knew you were okay?”

I had no idea, but I was relieved they’d arrived at that conclusion.

“Remember that rash?” she asked. “The four-year-old with the vesicles on his legs who’d just come back from camping?”

I remembered. Yet another patient that had had me stumped.

“When I asked what you thought it was, you said ‘I don’t know,’” she went on. “That’s when we knew we had a good resident.”

The other physicians agreed. “We don’t care what you know,” said Joan. “We care that you know what you know.”

* * * * * * *

I teach residents myself, now, and it’s true - I don’t pay particular attention to how comprehensive their knowledge bank is, but to whether they recognize what’s missing. Nothing raises a red flag like a learner who already has all the answers.

And then there are the patient encounters where you can’t turn to UptoDate for backup. Sometimes there really isn’t an answer, in that brisk bullet point way that physicians love. Sometimes the P of SOAP feels terribly inadequate; writing ‘counseled’ or ‘conservative’ or ‘follow’ feels like a fail. Physicians get the God-complex jokes all the time, but from where I sit, we're keenly aware of our limitations. Medicine teaches you how very much is unknown.

That's using the Gauss scoring lens to look at one field in one profession. Imagine if we approached everything from a place of humility.

I read comments on news articles on refugee matters, vociferous ones, that are ignorant of the basic facts of the system. I’ve heard someone predict the eternal destiny of another person’s soul with the same degree of certainty that they state their summer vacation plans. I’ve seen someone with no more than Biology 11 comment with the authority of an immunologist on vaccines.

I can't say that those lessons I've learned in medicine have overflowed into every other part of my life, either.

So how about each of us, the next time we’re in a conversation - with a client, in a staff meeting, on social media or out to dinner - consider whether we truly know the answer to the question at hand.

And if not, take two points for keeping our mouths shut.


Cross-posted at www.freshmd.com and www.mothersinmedicine.com


Friday, March 14, 2014

Guest post: Doubt

Wednesday, March 5, 2014
Queen Elizabeth Theatre

Every seat is taken. The theatre's lights are dimmed over a throng of excited Vancouverites, most dressed in black, some in pearls. After interminable introductions, Hillary Rodham Clinton strides in from stage right, in a navy pantsuit, stilettos and large glasses. She takes the podium and begins her speech on women's issues. She's funny, smart, engaging.

I'm here for the curiosity, not the politics. I was offered a ticket that morning; I didn't even know she was in town. She doesn't disappoint. Her presentation is riveting.

"One of the greatest blocks to the advancement of working women is their own self-doubt and perfectionism," she says.

Yes. That resonates.

She continues, "I've worked with many young people over the years, and almost invariably, when I offer more responsibility to a woman, the response is, 'Let me think about,' or 'Do you really think I could do it?' I have never once offered a promotion to a young man who did not feel more than entitled to it."

I post that to Twitter.

*        *        *        *        *       *       *
Friday, March 7, 2014
Residence, Deep Cove

I'm going through pictures of my brother's wedding from the week before when I come across this:
DSC05052

Whoa. How'd that happen? I've got a girl who babysits, attends youth group and just submitted her course selection for high school. If she goes to McGill for university as she intends, I have just over five more years of seeing this face at the breakfast table every morning.

Her childhood has always stretched ahead of me as far as I could see. The chances to do things with her, to become the mother I want to be - I live as if they will continue indefinitely. So how can it be that I can count on one hand the summer vacations remaining until she graduates high school?

Wait! I think, and I suddenly feel scared, sad. I was going to read all of the childhood classics alongside her - A. A. Milne, Roald Dahl, L. M. Montgomery. I collected them from used bookstores, and she's read them, but I never got around to it. I still haven't made her bedroom an idyllic nest; the board is on PInterest but the brown carpet lives on. The plan at the back of my mind was to raise her somewhere with goats and an orchard; we live on a rocky cliff side without even a gerbil.

I was going to become an excellent mom, or even just a really good one, the one she deserves. I could always see just how I'd be one day when I'd conquered all my personal faults. Calm and patient, attentive and selfless. I was going to start going along on field trips and watching her floor hockey tournaments. We would have long conversations lying on her bed in the evenings. I was not going to take her for granted, ever.

I look at the face in the picture above, sweet and spotted, pretty and confident. A flight of conflicting responses pass through me. Pride, panic, affection, sorrow. What to do?

Do I say with satisfaction - Look at that. She knows she is loved, and knows how to love. She's an excellent student, a kind friend. Tucked into the past twelve years are moments I didn't, couldn't have planned. Dissecting a cow heart for her class, sharing anecdotes about her baby sister, playing Clue after dinner for nights on end. I'm irritable and impatient, yes, but I've always been up for adventure. I devote a large part of myself to patients, and she sees the joy that good work can bring.

Or do I say, Hold up a minute! There's still time. Not a lot, and I'm going to have to be very deliberate about this, but there's still time. There are changes to be made, to home and work and heart, and we're turning this ship around, starting tomorrow.

*        *        *        *        *       *       *

Saturday night, March 8, 2014
Residence, Deep Cove

"Are you the father you wanted to be?" I ask Pete. I bring these things up in bed, lights out.

"I've never thought about it," he says. I can't believe it. But I do, deeply envious.

"Scale of 1 to 10."

"Ummm. Seven." No trace of guilt or sorrow.

I can't help myself. "Seven's kind of low. Don't you feel bad about that?"

"When you imagine being a parent, you have no idea what it involves. Once you're doing it and you find out what it's really like, you cut yourself some slack. Lots and lots of slack."



-- cross posted to www.freshmd.com --

Thursday, September 26, 2013

Guest post: In one's element

In his NYT bestseller 'The Element', Ken Robinson argues that we are in our element - doing what we should be doing - when we do the thing we love, and in doing it feel like our most authentic self.

This got my attention. I've often felt that the place I am most me is in the clinic, and I find that somewhat disturbing: how can that be, if my children and closest friends never experience me in that context? I feel I'm less the real me at home - or maybe that's wishful thinking. At any rate, I like myself best at work, and the following description by Robinson of people in their element holds true:
". . . time passes differently and they are more alive, more centered, and more vibrant than at any other times." p21
He suggests that we find ourselves in our element when four things align: aptitude, passion, attitude and opportunity. Because his description of the attitude necessary to find one's element (perseverence, ambition,  wanting something strongly and being willing to exert oneself for it) is, I think, almost universal among physicians, I've 've taken the liberty of replacing "attitude" with "need" for the purposes of applying this to medicine.

And so, the four pieces that fit together when in one's element
  1. aptitude (what you're good at)
  2. passion (what you love)
  3. a̶t̶t̶i̶t̶u̶d̶e̶ need (in the world, that your work fills)
  4. opportunity (a position where you can do the work)
I'm a good physician, I love medicine, I provide primary care to refugees, and I work in the only such clinic in the province. Perfect score.

Thinking over other positions from which I've moved on, or avoided, or wished for, I can identify which of the above was missing. I lost my passion for work in Vancouver's downtown east side when I came to view the work as palliative. In private practice in an affluent neighbourhood of Vancouver's worried well, the preponderance of women complaining that their hair had lost its lustre left me feeling my work wasn't filling a genuine need. I've avoided high acuity settings (emergency room, deliveries) because I haven't kept up those skills. And I don't work in a medical practice where I'm given paid time to write because I haven't found the opportunity.

I do think that health care workers have an advantage in finding our element in that the need is so obvious in our work. We care for sick people; what's more basic than that? It's less tangible for people like my husband, who works in business software. And I think it's more difficult still for artists to define and defend the need for their work.

The concept of opportunity trips me up a little.  My current job, and the one before that (HIV clinic) were both positions that I did not seek out. They were offered to me. Sometimes I second-guess myself: isn't accepting an opportunity a passive choice? Picking the low-hanging fruit? Shouldn't I be actively pursuing the perfect, hard-to-get position, chasing it down? (But what would that even be?)

Maybe we can increase our work satisfaction by changing what fills those four criteria. If I were to increase my skills (say, learning some basic surgical skills like appendectomies) and set up shop where there is greater need (rural Zambia) would I be even more satisfied? Perhaps that's why so many 50+ physicians do exactly that.

I like the idea of applying this framework to job considerations in the future. I've been dipping my toes into adminstrative work. There's a need for (young) medical administrators, and plenty of opportunities. But I haven't had enough experience yet to determine whether I have a passion for it, and whether I have (or can develop) the necessary skills. Whether I would find myself in my element there remains to be seen. At least I know what to look for:
"One of the strongest signs of being in the zone is a sense of freedom and of authenticity. When we are doing something that we love and are naturally good at, we are much more likely to feel centered in our true sense of self - to be who we feel we truly are." p90
And you? Are you currently in your element? If not, which is missing: skill, passion, need or opportunity?

[cross-posted at www.freshmd.com]

Saturday, February 25, 2012

Speaking engagement

I've agreed to a 45-minute presentation on medicine for my ten-year-old's science class this week.
What to do? I've considered percussing out a liver, telling the story of Alexander Fleming's serendipitous discovery of penicillin, suturing a banana, showing x-ray films of kids who've swallowed various inedible objects, warning against bezoars - let's face it, medicine's ridiculously interesting.

But what would prove most spell-binding to 28 grade-five kids? My daughter's certain I'm going to be awesome, and I can't disappoint her.

Please advise.

Monday, July 11, 2011

Feelings of loss post-partum

by FreshMD | Martina Scholtens

When Ilia was a few weeks old, Pete asked, and said it so casually from the couch where he was reading after dinner, "Do you miss our old life?" The relief to hear it said. I did. I missed the old routine, driving in to Vancouver in the mornings with four-year-old Ariana in the back seat, CBC on the radio and a day at the clinic ahead of me. Yes, there will be a similar routine in a few months, with an infant in the car and a graduated return to work, but those other days, the particular way they were, are done.

"I guess you'll never have another son-baby, hey, Mom?" asked my six-year-old son cheerfully as he ate his after school snack the next week. I could have cried. I saved all my kids' clothes in anticipation of this possible fourth, and now that she's here I have boxes of corduroy pants, sneakers, little ball caps to set afloat. Somehow my daughters' infancies seem preserved through Ilia wearing their hand-me-downs, but I can't kid myself: my son's baby days are over.

And then I overheard Ariana greeting her little sister. "Good morning, Ilia," she said seriously. "It's your medium-sized sister." Saskia's still the oldest, and Leif's still the only boy, but the crown of youngest child has been passed from Ariana to Ilia, by my choice. Then, after church an elderly woman tugged on my arm, admired the baby and confided, "Mothers have a very special relationship with their youngest daughter." At that moment Ariana came into view, long dark pigtails, thin legs in purple boots making their way across the room to the gardens outside. There she was, the daughter with whom I would have had that extra special relationship - except I'd taken that from us and given it to this newest baby.

Those first two months, I missed my bodies. The one before this last pregnancy. The one before I had ever been pregnant at all. The pregnant one, even, that at least looked purposeful. A week post-partum, sitting at the breakfast table, Leif gestured at my paunch with his spoon and asked, "You know why that looks like that? Because all the equipment is still in there."

Most of all, I've struggled with the (temporary) loss of my identity as physician. At the little good-bye party over cake in the chart room in February, I asked the clinic to please just stagnate until I returned. Of course they will forge ahead and do all sorts of interesting things while I'm away, and I hate to not be a part of it. Some of my patients requested six-month supplies of medications to tide them over until my return. I didn't comply, but I understood. I'm grateful for my locum, but I'm jealous of her, too. I miss the collegiality of the clinic, the focus on others' lives, the escape from my own head, the sense of contributing to the community, the academic stimulation. I'm back to work in the fall, but in the meantime, I feel a little unmoored.

This is my daughter:

Ilia

How I love this little face. I marvel that someone I couldn't have imagined months ago could feel so inevitable, could have an entire family happily orbiting around her.

Don't mistake this for ingratitude. It's simply an acknowledgment that for this new mother, mixed in with the bliss of those first six to eight weeks, were feelings of loss and grief. Surely I'm not the only one.

Monday, April 11, 2011

Kindness

by FreshMD

Last spring, my experience as physician, mother and patient intersected through a calamitous pregnancy loss. A few weeks ago (days after I delivered my daughter), my reflections on those events were published in CMAJ. As on-line access requires sign-in, I requested permission to post the entire article here. As always, details of patient encounters have been modified to preserve confidentiality. My physician gave his consent for publication.



An Eritrean couple first saw me at the refugee clinic four months ago in crisis with an unplanned pregnancy. "It is good now," he says today, gesturing at his wife's belly. "We are happy." It is their last prenatal visit before being transferred to an obstetrician. He says a little speech, thanking me for what I've done, the support and the kindness. "You helped us when we were new in the country, in trouble." I feel professional gratification that they were satisfied with my services, and tell them with sincere emphasis that it was my pleasure! to care for them. As I usher them out the door I've already forgotten their gratitude.

"That was a beautiful speech," says the nurse after they leave. "My patients in Uganda used to do that all the time." I look at her, and I think, Yes, yes it was beautiful. I've heard these speeches before, though, thanking me for kindness, and I feel embarrassed that I'm thanked for dispensing something that cost me nothing: no education, no honing of skill, no effort. I'd rather be thanked for diagnostic prowess or a deftly-performed procedure. But I extend kindness to patients habitually, with an extra measure when I have nothing else to offer.

* * * * *

Seated in my doctor's office, I'm in the chair tucked right next to his desk. This is the first visit that I haven't sat casually on the exam table with my legs dangling over the side, the first time I haven't popped in for something routine like a vaccination or contraception or a prenatal visit, where we talk shop and I ask about his daughter, a medical school classmate. This time, I'm here to follow up a disastrous ending to a second-trimester pregnancy. He knocks on the door, steps in, gives me a long, sober look as he slowly closes the door, sits down. He sits in silence. I can't look at him. Finally I force myself to talk, exhausted, crying, despairing and he listens. He leans over his desk, arms folded on it, looking down. Eventually I look at him, at his solemn white-bearded face, and I note that he is flushed. His eyes are damp. And I realize that he is moved by my distress, and I am completely taken aback.

Over the next few weeks, I think back to our encounter repeatedly. The memory of him sitting there, seemingly with all the time in the world, fully present, saying little but moved by my situation, is an enormous comfort. His kindness is more dear to me than anything he's done for our family over the years, even his delivery of my daughter.

I see him in follow-up two weeks later. The visit is such a solace that I am certain I am being extended divine kindness; my doctor is the unwitting priest. What a profession! What power! I imagine, longingly, that I could only extend the same to my patients.

And I realize with horror that this kindness which has impacted me so profoundly is the very one that I use unthinkingly in my own practice, that I dismiss as a personality trait, a last resort for patients for whom I have no medical therapy to recommend. I feel I have been wielding something powerful without any respect for it.

* * * * *

Back at work, I determine to be conscious of what I give to patients, and to receive what they return to me. An elderly Congolese patient with severe osteoarthritis has found a French-speaking family physician near her home. She makes a short, thankful speech, and this time I don't dismiss the gratitude as grossly disproportionate to what I've done for her. "Every visit, I felt better just to see you," she says. She hugs me; I feel very slight. She presses her cheek against mine and I can feel and smell her hair. "Don't forget me," she says through the interpreter. "Come visit my home."

* * * * *

Weeks later, I see my doctor again. I'm doing much better, and he seems mystified as to why I've come. I wanted to check in, I explain. I can see him trying to figure out what I really want from him, thinking we're doing the doctor-doctor visit dance, where he must guess the investigation, referral or prescription I have in mind. He offers a medication, and I decline. He offers a different one, but I don't want any medications. He asks again why I've come. He has no idea, I realize, no idea how therapeutic his presence is. I don't want to alarm him, so I don't give him the simplest answer: that all I needed, quite literally, was to see the doctor.


Monday, March 28, 2011

Delivered of a baby girl

by FreshMD

I gave birth to a baby girl four weeks ago.

This is where the statistics go, the measurements and time of birth, precise - to the gram, to the minute.

What I really want to tell, though, are those other details. That my semi-retired doctor came up from a day at his cabin digging a garden for raspberry canes, for his last delivery. The warm blankets piled on me postpartum, white flannel with pink and blue stripes, the softness gone after hundreds of launderings - how they reminded me so strongly of both nights on call in the same hospital and my previous deliveries. The nevi simplex on my newborn daughter's eyelids, symmetrical flames, perfect.

Raspberry canes? Those are just the hormones talking, said my girlfriend flatly. So maybe it is. What does it matter what gives that magnification to the incidental facts around her birth? I'm still sifting through the experience, letting the details settle. I don't have any perspective yet, and I'm hardly coherent. And that's why, although I expected to post about her within days, I haven't.

Here's what I can tell you:

Her name is Ilia Tove. Yes, I realize the name has all sorts of possibilities for medical bastardization.* I proposed the name Imogen but that struck my software husband as sounding like a photo app. Ilia is the female variant of Elijah, and means 'My God is the Lord.'

Several times the entire family has spontaneously migrated to her room, forming an admiring semi-circle around her crib. Her siblings adore her. "Hey Ilia!" said my six-year-old the first time he met her, waving his hands gently in her face. "Dynamite!" and his fingers burst apart in a soft explosion. The four-year-old imitates her Moro reflex perfectly. And my nine-year-old has been poring over my baby books: "Mom! Did you know that in a few months you can mash up a banana and feed it to her?"

Her first week she attended three show-and-tells. "She breastfeeds," my son told his Grade 1 class. "She breastfeeds breast milk. From my mom's breasts." He patted my right breast for good measure. "All her life, my mom's body has been saving all the milk she ever drank to feed this baby," he went on knowledgeably. "It even saved all the milk my mom drank as a little girl."

And me? I feel rich. Three daughters and a son. I don't take it for granted for a moment.

Before I left the hospital the public health liaison took a history from me and asked after my occupation. "I'm a family doctor at a refugee clinic," I said, and I was almost startled to hear myself say it, as if I'd suddenly remembered it. I turned away as tears came. Hormones and lack of sleep, yes; and a sudden brief nostalgia for a life that seemed to have very rapidly receded. Most of all, though, the grateful realization, as I sat cross-legged in the hospital bed with my infant daughter in my lap, considering my work, that I have this - and I have that, too.


*cilia, milia, ill, iliac, ileum, ileus . . .

Monday, February 7, 2011

One clinic day, three responses to my pregnancy

I dislike that pregnancy forces me to bring my personal life into the office. I don't have pictures of my kids on my desk, I am vague when curious patients ask where I live and on Monday mornings I never volunteer my weekend activities to the staff.

But this pregnant belly, no matter how discreetly swathed in muted professional clothes, begs comment from everybody.

* * *

A patient comes to see me for follow-up after a miscarriage. I am acutely aware of how difficult it might be for her to see her doctor pregnant.

As I call her from the waiting room I feel that I am flaunting my fertility. I will my belly to shrink down a little, to look less jaunty, but her gaze is fixed on it as she approaches. She grabs my arm, looks at me earnestly, and says, "I'm happy for you. I really am." And I can tell - she really is - and I am moved by her graciousness.

* * *

I'm signing off results, standing in the reception area with my Sharpie fineliner in hand and a stack of cream-coloured files in front of me. One of the secretaries swivels around in her chair. "Hi, Mama!" she exclaims. I look up briefly, say hello, and slide the next chart towards me.

She looks me up and down and beams. "When I was pregnant with my first . . . " she begins, and I only half-listen as I methodically sign off hemoglobin levels and ultrasound reports.

I snap to attention, though, when I hear, "You've even got a bit of a booty now, eh?" I turn to look at her, and my expression must have some level of fierceness to it because she quickly amends, "Only a very small one, though," and turns hastily back to her keyboard.

* * *

I have lunch with a colleague in town for a conference, a forty-something man with no children, and he asks what benefits I receive as a member of our provincial medical association. I list them: CME funds, malpractice insurance, an RRSP program, maternity leave benefits --

He interrupts me. "Why should others pay for your lifestyle choice?" he asks bitterly. He gives a short diatribe on the injustices borne by childless men. I try to interject but give up when he complains about having to pay taxes for neighbourhood schools which don't benefit him directly.

"If you get a leave to have a baby, I should get paid leave to take a water-colour painting course," he concludes.

A few days later he swings by my office. He sets a steaming coffee on my desk and offers, "You can have as many children as you want, Martina."

Sunday, December 19, 2010

Ten guidelines for medicine-life balance

Right now, this month, seven years out of residency with a part-time position at the refugee clinic and three and three-quarters children, I have work-life balance. It's somewhat precarious, something that could be toppled by illness or an unbearable colleague or a newborn, but I would rate my current satisfaction with both career and home life as high. Here are some philosophical and practical guidelines that I follow:

1. Accept that you can't have it all - at least not at once - but you can have a life that is rich and full and satisfying. I watch resignedly as other (childless) physicians at my clinic leave to spend months working in Afghanistan and Peru. I'm the mother that arrives late to the preschool Christmas potluck and sets a box of mandarin oranges next to the homemade cheesy noodle casseroles. My son's school uniform pants are embarrassingly short and I couldn't make a recent cross-cultural mental health conference because I'm home with my daughter on Thursdays. But I have kind, secure children and what is arguably the most delightful, rewarding patient population in the city. It's enough.

2. Be clear about your boundaries and don't apologize for them. I work Mondays, Tuesdays and Fridays. I can't start any earlier than 9AM due to school drop-off. I've had potential employers rework schedules and change clinic start times when I tell them my availability.

3. Don't compare your finances to others'. Recently, my six-year-old son asked me, "Where do you and Daddy get money from?" He was taken aback when I explained that we are paid for our work. All this time he had assumed we were going to work for pleasure and to help others. This pleased me no end. I don't want money to be the prime consideration in my decisions.

Every year the BC Ministry of Health puts out the "Blue Book", which lists what every physician in the province billed the Medical Services Plan. I've perused it before, but no good comes from seeing that my family physician neighbour bills more than five times what I do. I start to gauge the wrong things in terms of money; what are quiet days at home puttering in the yard with my four-year-old worth?

4. Say no. This may be the most important skill I've learned in the last five years. If I feel awkward saying no to someone's face, I say I'll consider their request. Then I say no by email. I don't bother with reasons or excuses. I came across a quote from one of Dr. Gabor Mate's books a few months ago that I think of almost daily: "Always choose guilt over resentment."

5. Write. I take ten minutes once or twice a week to document for myself what was memorable. This has a magical way of allowing what's important to rise to the top while the irritations of daily life drift away, affording perspective. Here's something lifted directly from a journal entry this summer:
Playland yesterday, Leif smiling as he soared through the air, Saskia looking non-plussed even when having a great time. It felt wonderful to give them a day of whatever they wanted, unlimited rides, mini-donuts, cotton candy, a snowie despite wasps hovering over the syrup spigots, eaten cross-legged on concrete in makeshift shade. They were good as gold. Felt strange to see legs dangling from a great height, delighted screams, ferris wheel buckets the colours of candy against the North Shore mountains, and think that the same world has refugee camps.
6. Consider exhaustion the state of having given, rather than having been taken from. A few months ago, as I rounded the bend to approach the Second Narrows Bridge on my way home from work, CBC's Rich Terfry on the radio and Ariana strapped in the backseat, I thought with dismay how overwhelmingly fatigued I was. I felt drained, spent, exhausted - and reflecting on these words I realized that resenting others having taken from me was passive and inaccurate. I had given what I had by my own choice. When considering Dr. William Osler's words, "Let each day's work absorb your entire energy and satisfy your widest ambition," anything short of collapsing into bed completely spent each night feels a waste.

7. Travel lightly. I try to apply minimalism to every aspect of my life. People remark on how tidy my home is, but the truth is that we have very little stuff. I decided two years ago to leave the HIV clinic to focus my part-time work at the refugee clinic only. We eat simply. Any commitments are carefully selected and for a defined period of time.

8. Hold an AGM with your spouse. Once a year, Pete and I hire a babysitter and take an evening to take stock of where we're at in every major area of our life: his work, my work, finances, church, where we live, parenting, friendships. We identify what's working, what needs to change and when we need to reevaluate. We like to feel that our choices are deliberate; we don't want to float up to our forties to say, "Huh! So this is how we live." I have such fond memories of these evenings, full of gratitude and brainstorming and collaboration, and everything recorded in my notebook.

9. Three projects. At any given time, I have three projects on the go that require one to two weeks to complete. One relates to work, one to home and one to something creative. For example, I might apply for a research grant, order a coffee table and frame some of my photos for our front entry. No new projects can be tackled until all of the original three are completed. (See zenhabits for more.)

10. Marry well. Pete (who works full-time in a non-medical field) is supportive, a non-complainer, hands-on with the kids and flexible around gender roles. We've both made sacrifices. He is undoubtedly the linchpin to my current contented state of mother-doctor.

I've loved William Wordsworth's poem "Nuns Fret Not at Their Convent's Narrow Room" since I studied it in English 103, particularly these lines:
In truth the prison, unto which we doom
Ourselves, no prison is.
I'm a mother in medicine by choice. I accept any challenges and restrictions inherent to this position, for this is exactly where I wish to be.

Friday, December 3, 2010

Fourth and final

The immediate, unmistakable second pink line on the test laid on the bathroom counter - oh, the power of that pink line. The possibility that it stands for, the hope for a healthy pregnancy and a perfect newborn and another loved child. One slim line that releases a cascade of happy plans.

And yet, personal and professional experience with pregnancy loss have primed me to assume nothing. I'm expecting strikes me as presumptuous. And so I am not expecting. But I am pregnant.

On discovering I had conceived, I was overwhelmed by the sense that this was obviously grand work, this close involvement with birth, and briefly, all else looked anemic. I am thrilled, at least as much as I can remember with my other children. It doesn't feel commonplace; my previous experiences - good and bad - make it that much more meaningful. It's been almost five years since Ariana was born. This me, the 36-year-old mother of three, physician to refugees, living in Deep Cove, has never been pregnant.

I first felt the baby move at sixteen weeks: a soft swipe, a sliding sensation. Then the movements changed to knocks, small thuds, bumps and turns. I often lie on the couch, pants unbuttoned, both hands on my belly, waiting for baby to buck and shift; its solid presence can take my breath away.

I'm 27 weeks, 3 days. I have a globe of a belly, a baby cardigan on the needles, three very pleased children and a non-stop pace at the office that keeps baby rocked to sleep most of the day.

I'm in no hurry to progress. Right now, everything is as it should be.

Thursday, October 7, 2010

Hate mail, non-anonymous blogging and a favourite comment

I started my personal blog in October 2007, when I was working part-time and mother to a one-, three- and six-year-old. It made perfect sense to me that I take up blogging during the very busiest time of my life: blog posts were tidy, tangible, creative packages I could set afloat on the Internet, when everything else in my life felt messy and abstract.

I knew that if my blog attracted any kind of readership, I could expect hate mail. I prepared myself by deciding that when the first nasty comment arrived, I would see it as an accomplishment, a marker of an ever-widening circle of readers. Then someone called my kids f***ing ugly and interpreting that as a mark of success proved more difficult than I had anticipated.

All posts are vetted by Pete. On more than one occasion he's responded with, "I'd actually file that in the Who Cares Department." I post those ones anyway and invariably they're particularly well-received.

I've never blogged anonymously. For one, I wanted to take responsibility for what I wrote. I also wanted full credit for it. When I write, I consider that anyone could be reading: patients, employers, ex-boyfriends, my mother, my child's teacher. This keeps me cautious, and keeps blogging from landing me in any sort of real trouble. That also means that out of respect for family, friends and even institutions, most of the very best fodder for writing is off-limits.

For example, I won't write about:
  • being actively discouraged from pursuing medicine by family
  • being raised in a small, religiously and ethnically homogeneous community wherein women pursuing careers was rare and having a child in formal daycare was unheard of
  • the refining of my Christian views as medicine affords me glimpses into human hearts, lives and suffering
  • the complexities of relationships with friends who home birth, don't vaccinate and seek medical advice through Facebook status updates
Though I no longer blog at freshmd.com for reasons detailed here, I continue to blog at Mothers in Medicine for several reasons. For one, writing is a good exercise in putting one's thoughts in order. I agree with Emily Carr:
It seems to me that it helps to write thoughts and things down. It makes the unworthy ones look more shame-faced and helps to place the better ones for sure in our minds.
For another, I value having records of events. I am certain I would not remember the small details of my son's radial/ulnar fracture had I not documented it. I'm grateful I made the effort to describe what my typical day looks like. For me, writing captures memories far better than photography does. It also feels like the most authentic me; my writing represents me much more accurately then my CV, or my wardrobe, or my library.

But what I enjoy most about blogging is having others derive pleasure from my writing. The best blog comment I ever received was from someone who wrote:
When I saw that you were gonna describe each of your morning patients I got so excited I actually got a bowl of chips and some coke to thoroughly enjoy the read.
When I tell a story face-to-face, the response is immediate. When a piece is published in a journal, that very fact is affirmation enough. But a blog audience, for the most part, reads in silence, and that inscrutability can be unnerving. Learning that someone out there is settling in with a snack to enjoy a post is a huge incentive to continue.

Wednesday, June 16, 2010

Looking older

I've always looked young, and received countless remarks to the same as a medical student. The comments were made in a marveling or appreciative way, but as a novice struggling to project confidence and professionalism, I didn't find them helpful.
Aged 24. I am radiating something here, but it's not life experience.

Of course, it became much more tolerable a few years later when I was twenty-eight and being taken for twenty-two. And then I had three children, and I'd been in practice a few years, and comments on my age trailed off. One day last year a patient said to me, "You must be about my age - from 1974?" and I was shocked that he had nailed it. Shortly after, for the first time ever, I asked my hairdresser for a cut that would take a few years off. Now I have bangs.

Then last month my patient, a widowed Iraqi refugee with three teenaged daughters, asked me through the interpreter, "As a woman, how do you be strong, but kind and loving and forgiving at the same time?" She looked at me expectantly; she wanted an answer. And I recognized that this was less a patient asking a question of her doctor, and more a woman asking a question of another woman. I was moved that she would think I had any advice to give her. I am fifteen years her junior and certain that my life has not required the strength and forgiveness of me that hers has asked of her.

As I offered my ideas on the subject, I wondered whether the twenty-five-year-old me - ten years ago - would have had anything to say. I doubt it. In fact, I seriously doubt that anyone would have asked my fresh-faced self such a question in residency or early practice.

It is a rare moment when I acknowledge that there may be advantages to not being or looking twenty-two. If my aging suggests to patients that I have lived even a little, and have learned something from it, I am grateful for it.

Aged 35. Zoom in for crow's feet, dark smudges under eyes and four white hairs in those bangs.

Thursday, April 8, 2010

Disgusting

Abscess incision and drainage does not disgust me; in fact, I find it out-and-out gratifying. Most clinical events which might make non-medical types blanch induce absolutely no squeamishness in myself, including hemorrhage, open fractures, limb amputation and digital rectal exams. Diagnosing lice makes my own head violently itchy but doesn't make me squirm. Contrary to the belief of every patient whom I have asked to remove their shoes, feet - no matter what their condition - will not offend me. Same goes for unshaven legs and unmanicured perineums: I truly take no notice.

As a mother, the list of biological events with potential to repulse me has long since dwindled to almost nothing. I have survived the following with grace: vomit splashed down the neckline of my shirt, infant stool jetting up the back of a onesie and beyond, nares perpetually flowing with green discharge, and potty-training errors on carpet.

Between the two professions, I've got almost all offensive agents mastered. Almost. There are a few holders-on whose power to disgust me I can't dislodge:

  1. Soiled bandages. Whether it's gauze peeled from a surgical incision or a tiny band-aid ring that's fallen from my daughter's toe, there's something about absorbed drainage that I find revolting.
  2. Eyes. Specifically: globe rupture.
  3. Earwax. Cerumen being flushed into a little basin in my office is acceptable. Q-tips dropped into a wastebasket without being shrouded in Kleenex is not.
  4. Collections of cheesy substance in body creases of those who don't wash with due diligence.
  5. Vermin. I'll examine insect bites with interest, but bedbugs scuttling from the cuffs of a patient's shirtsleeves across my desk is too much.
  6. Prolonged coughing or throat-clearing where the sputum is clearly substantial in amount but difficult to expel.

Tell me yours.

Wednesday, December 9, 2009

A day at the refugee clinic

I get up at 6:40, always reluctantly. I shuffle downstairs to eat a bowl of granola with yogurt while checking email. Ten minutes later Ariana shouts from her bed, "I want to wake up now! Time to wake up!" and forty-five minutes of prodding three kids through the morning routine begins. If they are dressed and seated at the table by 7:30, I make them tea in a white elephant teapot.

We wind our way out of Deep Cove, dark waters to our left and hulking mountains to our right, with CBC Radio 2 playing. I adore Tom Allen's voice and think how my patients would benefit if I could speak in such kind, good-humoured tones. Forty-five minutes later and I've dropped two kids off at school, the youngest at preschool, and parked the van in a neighbourhood five blocks from the clinic.

As I walk to work, I often dread a day of seeing patients. I wish desperately that I were a pathologist working at VGH, looking up from my microscope periodically to gaze out over a view of False Creek. I feel immense pressure to be fully present for each of my patients and in the moments leading up to the start of my day it sometimes feels unbearable.

I am one of five part-time family physicians at the refugee clinic. I typically have five 30-minute appointments booked for the morning.

9:00 My first patient is a 27-year-old Ethiopian woman with a new diagnosis of HIV. I break the news through the interpreter, who is clearly shaken. The patient is distraught. I explain that HIV care and prognosis is different in Canada than it was in her village. Grim though this task is, the face-to-face, front line provision of care to this crying woman seated before me strikes me as an incredible privilege on my part, and any longing for the detachment of a pathology lab slips away.

9:30 The next patient is an elderly Afghani widow with hypertension and depression, well-known to me. At the end of the visit she tells me that when her son was severely wounded in Afghanistan years ago he became a pastry chef. She produces two Ziploc bags of cardamom-flavoured pastries, one for me, the other for the interpreter.

10:00 A 42-year-old Burmese woman comes in for her first well-woman check. I do a pap smear, bimanual exam and breast exam. She had never heard of these exams before I introduced the concept at her last visit. The idea of screening for disease, rather than treating it as it presents, is a novelty to her.

10:30 An elderly Bhutanese man, illiterate in his own language, presents with symptoms of prostatic enlargement. I pull up a diagram of the prostate on Google images and he stares at it. I am not sure how effective my teaching is.

11:00 A Congolese woman comes in for follow-up of her PTSD. She also needs documentation of her torture scars for a medicolegal report. She weeps as she describes how each wound was inflicted. I make detailed notes and feel ashamed of the human race.

The morning is not quite that orderly. One patient brings her two children, and because they've spent ninety minutes getting here on public transit, I feel compelled to fit them in. Two patients are late. The other physician and the psychologist tussle with me over the Farsi interpreter. An infectious disease physician calls to discuss my patient with echinococcosis. The nurse taps on the door to ask for a signature on a parasite medication prescription.

I leave for a quick lunch with my colleague at the Indian place a block away. We head out the back way, bypassing the waiting room that's already filling with the afternoon patients. The clinic is so busy that taking time to eat or pee induces feelings of guilt.

I see prenatal patients on Tuesday afternoons. I have a medical student today. I let her palpate fetal parts and find the heartbeat with the doptone. She is thrilled; I can tell she's going to tell her classmates all about it tomorrow and I feel nostalgic for those fresh and glowing medical student days.

I'm ravenous with hunger by the end of the afternoon, and briefly consider the Fibre One cereal samples, Tums smoothies and chocolate Caltrate Soft Chews in the cupboards. I resist and head out into the December cold to pick up Ariana.

Forty minutes later we pull into our driveway. The cedars are stirring from the wind blowing up Indian Arm and the docks across the water are decorated with Christmas lights. Deep Cove is serene and worth the commute.

I open the front door and the entrance way is strewn with backpacks and toques. We head up to the kitchen where Pete - who cooks every night - has prepared a meal of grilled salmon, asparagus and French bread. Everyone tells anecdotes from their days, including me, but the story I attempt to tell Pete is interrupted so many times that it fizzles out and doesn't seem worth finishing.

I put the kids to bed at 7:00. I crawl under the covers with my five-year-old for a few moments and he suggests, "Hey! How about you move out of Daddy's room and move in here with me?"

I answer any urgent emails and then watch a movie, too often something like Blood Diamond or The Killing Fields or Lost Boys of Sudan, one that turns out to be overwhelming after a day at the clinic. If we've thought to chlorinate the hot tub, Pete and I will spend ten minutes before bed with piping hot water up to our necks, gazing out at the towering spruce trees across the way and the moon on the water.

And then bed, the sweet, delicious coolness of sheets and pillow, and I am asleep in minutes.

Friday, November 6, 2009

The antidote: knitting

Ariana in handknit sweater
Ariana at 3 weeks, wearing a sweater I knit during my pregnancy. Had she been a boy, I would have still made him wear it home from the hospital.

Eight years ago I agreed to join a friend for an evening knitting course taught by a black heterosexual volleyball player named Steve out of a converted Vancouver warehouse. I've not stopped knitting since. It has proven to be the perfect antidote to medicine and parenting.

I'm working on a spruce-coloured cabled vest for my five-year-old, and when I knit a few rows in the evening the steady soft clicking of the needles work the yarn into perfect V's of stockinette stitch that are blessedly tangible. Row by row, cable by cable, visible results emerge. Measurable progress is directly proportional to the work I put into the project. Such is not the way of medicine or parenting.

The stitches behave. My needles cooperate. I control every aspect of the garment-making process. When I put it aside for a week, it is exactly as I left it when I retrieve it. Unlike disease, patients, offices or children, it has no life of its own. There are no surprises.

Reading Beatrix Potter
Leif reading Beatrix Potter on a Sunday afternoon. Vest not limited to professorial pursuits; also good for walks in the woods or autumn beach visits.

There is every opportunity for perfection. It is possible to knit an item flawlessly. If this were only true at home or in the office: all errors can be undone, most with nothing more than a crochet hook.

In The Artist's Way Julia Cameron discusses the importance of filling the well - replenishing our creative resources. She gives another reason to knit:
Any regular, repetitive action primes the well . . . Needlework, by definition regular and repetitive, both soothes and stimulates the artist within . . . [and] may tip us over from our logic brain into our more creative artist brain. Solutions to sticky creative problems may bubble up . . .
I do love the organic, messy, unpredictable nature of medicine and mothering. But that's what fills most of my days, and a moment stolen to give my hands over to bamboo needles and wool grounds me, lets my whirling thoughts settle and the most worthwhile rise to the top. An inch or two of knitting later - of perfect, even, countable stitches - I am ready to get on with real life.

Blackberry picking on a Saturday morning
Toque for early morning September blackberry picking.

Wednesday, September 16, 2009

I put an embryo on a daycare waitlist

September 2001

One year and three months into a two-year residency, I give birth to my daughter. I am eligible for one year of maternity leave, and have every intention of staying home with my sweet, big-eyed Saskia for all fifty-two weeks.* Pete and I haven't yet decided what we'll do for childcare when the year is up, but daycare isn't even on the table. I grew up understanding that daycare was for the unfortunate children of selfish mothers. It was fact, just as neighbours who mowed their lawns on Sundays could not be Christians.

January 2002

I sit at the desk in our loft, looking at a list of home daycares. The nine remaining months of residency loom over my days with my infant daughter. I have an irrational fear that I will have a series of consecutive pregnancies - defying all contraceptive measures - causing a perma-maternity leave and precluding any possibility of ever finishing residency. I am desperate to be done with it.

My residency program agrees to my request to return half-time, five mornings a week. We have no family nearby, a nanny seems like overkill and I am prejudiced towards group daycare, so in-home daycare seems like the best option.

Saskia lies on a blanket on the floor next to my desk in a fuzzy purple sleeper, arms waving, and as I dial the first number I feel sick to my stomach. It remains one of the most profoundly distressing moments of my life.

I dial and wait for the kind voice of soft, grey-haired caregiver. A man answers instead, hands the phone to his wife. I can't do it. I imagine my daughter in a stranger's basement rec room, husband and teenage sons coming and going, and I hang up.

I resort to calling institutional daycares. The only one that has an opening is attached to the local high school and cares for the infants of teen mothers so they can stay in school. I take it.

February 2002

It is a relief to be back in residency, end in sight. I love immersing myself in medicine again, and trundling Saskia home in the stroller in the early afternoon is ideal. I do have some anxieties. After the first week of daycare I marvel that she hasn't been abducted from the centre yet. Somehow it seemed that the moment she left my arms she would be in imminent danger.

Months later, a video of the daycare is shown at a gathering of Vancouver's who's who to raise funds for the support of teenage mothers. Several physicians recognize me in the footage and are confused.

Summer 2002

I've waitlisted Saskia at all the best daycares in Vancouver. A spot opens up at my top choice, a daycare attached to a hospital that has an infant, toddler and preschool division. Now I sign in Saskia and hang up her poncho alongside colleagues in medicine, research and physiotherapy instead of fifteen-year-olds.

We bring Saskia every day to energetic ECE-certified women who love their jobs. The child-teacher ratio ranges from 1:3 in the infant room to 1:4 in the preschool. Daycare doesn't call in sick, move out of town or take vacation. Saskia thrives and we are relieved and grateful.

2003

I finish residency. We reduce Saskia's childcare to two days a week and I work part-time.

I conceive and put the embryo on the daycare wait list. Eight weeks later we announce the pregnancy to our parents.

Spring 2005

A spot opens for my three-month-old son, but he's not eligible to attend until he's six months old. To retain it I pay full daycare fees for those months. I am ashamed that we resort to this, but it's common practice in daycare situations and the truth is, we'll do almost anything to get and keep a spot in a daycare with over eight hundred families on the waitlist.

When Leif finally joins the daycare, his caregivers in the infant room are the same ones that cared for my daughter three years ago. There has been virtually no turnover. They love him as they did my daughter.

Summer 2006


We move to Deep Cove, a half hour away from the daycare, and don't even consider changing our charmed childcare situation. Daycare close to work is much more convenient that daycare close to home, anyway.

I have my third child, Ariana, and we repeat the embryonic registration and retainer fee scenario that occurred with Leif.

September 16, 2009

My two oldest are in school, and Ariana still attends the same daycare two days a week, taught by the same teachers that cared for Saskia and Leif. I've been buzzing myself through that red front door with a little backpack on my arm for over seven years now. It's a comfortable part of our routine. So comfortable, in fact, that - behind on laundry this week - I sent Ariana to daycare in a pair of her brother's briefs, knowing I wouldn't hear a whisper of judgment.

* I am Canadian

Monday, July 27, 2009

Deadline for worthwhile work: age 40?

Take the sum of human achievement in action, in science, in art, in literature—subtract the work of the men above forty, and while we should miss great treasures, even priceless treasures, we would practically be where we are today . . . The effective, moving, vitalizing work of the world is done between the ages of twenty-five and forty.

Sir William Osler, "The Fixed Period", farewell address at Johns Hopkins Medical School, 1905

I came across this quote by renowned Canadian physician William Osler a few months ago and found it disconcerting. Not because I disagree with it, but because I wonder if there might be truth in it. And because I am a thirty-five year-old mother of three who has been treading water career-wise, working two days a week, with plans to truly launch myself professionally in another five years or so.

Then I watched In the Shadow of the Moon last week, Ron Howard's documentary on the moon landings, and was struck by the fact that Neil Armstrong, Buzz Aldrin and Mike Collins were all 38 when they flew to the moon in 1969. Arguably at the pinnacle of their careers, they were three years older than I am.

So I find myself wondering - have I already peaked? Have the opportunities for my best professional work slipped by while I've been laundering onesies and making homemade chicken stock? Or have they simply been postponed, with the next decade being my professional hurrah, as hoped?

My twenties were characterized by energy and optimism. My thirties have seen an indisputable downturn in both, but gains in insight and creativity. I thought perhaps each decade would burnish some new qualities, culminating at age . . . fifty-five? sixty? I don't really think that far ahead. But I was certainly counting on having more than the next five years to make my mark.

So - if you are at the end of your career, at what age did you make your greatest contributions? If you have passed forty, do you feel that your most productive years are behind you? And if you aren't yet forty, what years do you expect will be your best?

Wednesday, May 27, 2009

MiM celebrates one year: FreshMD

The end of this month marks Mothers in Medicine's one year anniversary. In honor of this great occasion, I asked our writers to share their favorite post (of their own) from the last year. Throughout the month, I'll be highlighting their picks.

FreshMD was one of the first women I recruited to join MiM. I came across her personal blog and fell a little bit in love. Since then, we've enjoyed her poignant, articulate, witty, insightful posts here on Mothers in Medicine.

She writes:

"Hmmm, hard to decide. I think this one: http://www.mothersinmedicine.com/2008/11/full-days-work-by-9-am.html

It was fun to review them! I don't remember writing some parts. Some of the details about my son breaking his arm I had no recollection of."

FreshMD, thank you, for writing with us for the past year. We wouldn't be the same without you. (And while we are sad to hear you will no longer be posting at your personal blog, we are glad you will be able to pursue new creative endeavors and thrilled we can still read your words and insight here.)

Tuesday, May 26, 2009

Dandelion poetry

We brought dinner to the beach last week, and afterwards we walked out to the dock and played along the shore. Leif found a cluster of dandelions gone to seed and hunched over, snapping the hollow milky stems and double fisting his prize.

"I'm going to make a wish!" he said. "I wish for . . . " I could see him searching for something extravagant. "A chocolate cake!" he said expansively.

puff puff spit huff spit puff

"I'm not going to blow anymore. I'm just going to whack the wishes off now," he said, striking the fluff balls against the railing, then plucking them apart manually. "Look - a school of wishes!" He watched them drift off in a hazy clump. "Hey! The wishes are all hugging each other!" And then he spotted some goslings and trotted off down the beach.

How wonderful to wish for chocolate cake. To have to think hard for something to wish for, to have all your needs met, to have no cares or sickness or worries to wish away.

For me, my children and their pure, unspoiled interactions with the world are the most potent antidote to the suffering I witness at work and sometimes carry home with me as a little black cloud over my heart.