Showing posts with label Genmedmom. Show all posts
Showing posts with label Genmedmom. Show all posts

Monday, May 1, 2017

On Quacks, and Cold Clinical Facts

Genmedmom here. 

We all have patients, friends, and family members who fervently believe that they have a diagnosis that we know doesn't exist. Or rather, for which there is no current reasonable believable scientific evidence.

I refuse to cite specific examples, because it's useless to refute someone's pet diagnosis. You may have examined a large body of research, read reams of textbook pathophysiology, spoken to respected specialists, but no matter what, if you attempt to disprove the entity they blame for all of their symptoms, and the treatment upon which they have pinned their hopes, they will hate you.

It's unfathomable to me that there are providers out there, some of them medical doctors, who blithely and blatantly practice non-evidence-based medicine on unsuspecting and vulnerable humans.

Infuriating.

And it sucks to sit there and listen to someone you care about describing quacky tests and (at best) useless and (at worst) potentially harmful charlatan treatments. Especially when they are paying dearly, and out-of-pocket.

Of course, I've tried to take down these totally false medical problems many times. It's what you do when you care about someone, right? And I've watched their faces shut down, as they mentally walk out the door. Or, saw them get red-faced and argumentative, unable to hear another word I said.

Sigh. So now, for the most part, I nod and smile and murmur something about how modern science can't answer all the questions and I hope that's working out for them.

After all, I can see why this is happening. Modern day M.D.'s are obviously missing something. Patients aren't getting what they need from us.

It used to be that folks had a local doctor who knew them well (and possibly also their families, neighbors, and friends). Office visits were longer, and paperwork was practically nonexistent. There was more listening, and less prescribing. The pace of the research world and life generally was slower, and slower to change. Hypotheses, explanations, and medications were more stable, things you could get your head around and use for a long stretch of time. The doctor-patient relationship was a real thing.

All that's a fever dream. Now, we docs are SO on the clock. Productivity numbers are in- you need to see more patients! And more! Twenty minutes to address all of your patient's medical problems and questions, examine, order, NEXT! Then, the deskwork. Administrative burden outmatches face-to-face clinical time two to one. It's a team of nurses doing callbacks, if the patient gets a call at all. Nowadays, it's mostly messaging through the "patient portal". The, the general public is fed research study after study after study. Papers and pundits contradict each other, data is manipulated, organizations release conflicting guidelines, medications get pulled. Textbooks aren't even printed anymore because they're outdated so fast. What a mess.

These are the cold clinical truths: There's no time to build trust. Our system prevents real connection. The scientific information world is fast-paced, chaotic, and confusing.

And so people are looking elsewhere.

Our medical system may or may not be headed in a better direction, what with the Patient Centered Medical Home movement and all. We'll see.

But meantime, behind the scenes, I am on a bit of a campaign. I recently wrote a patient-friendly article in support of evidence-based medicine for Harvard Health Blog that was well-received. At least, I didn't get any death threats.

Death threats, you say? Yes! Plenty of qualified critics of particularly trendy fake diagnoses suffer angry trolls throwing cyber-insults or writing letters with intent to harm, or kill.

So I'm trying to educate generally, not specifically. Trying to teach people how to tease apart the "fake news" from the safe news, how to be thoughtful, and consider several sides of a story. Their doctor sees it one way, but the internet says it another way. Okay, let's figure this out.

Doctors, we won't win the battle against the snake oil salesmen using facts and figures. We need to be gentle. Tread lightly. Nod and smile and murmur something about how modern science can't answer all the questions and you hope that's working out for them.

And then, if we can, listen. Try to cut through the requisite logistical bullshit and reach out to our patients. If they are feeling heard, they may trust. And if they trust, they may listen. It will take time, and open minds on both sides. But the patient may get the expert help they need, that the doctor is able to give.




Monday, April 24, 2017

We lost our s--t with the stranger who criticized our kid

Genmedmom here.

Hubby and I are not proud of our behavior. As a matter of fact, if anyone at the suburban quick- service restaurant managed to videotape us losing our sh-t, we'll be mortified.

Saturday was Earth Day as well as the March for Science, so we took our kids downtown to meet up with friends for breakfast and then show our support for our planet. Of course it was lovely and inspiring and all, so when we had to cut out early for a birthday party, we were a little bummed. On the other hand, the day was raw and rainy, so we were also a little relieved.

At the train station, a balloon man made a blue balloon sword for Babyboy and a pink poodle for Babygirl. Halfway home, rather predictably, Babyboy's sword popped. He wailed, then pouted, as Babygirl "helpfully" reminded him that HER balloon toy was still like new.

We didn't quite realize how upset he was about the balloon. And also, perhaps, how exhausted from our packed day thus far, dealing with new people at breakfast, trekking all over the downtown area, managing myriad sights and sounds and general chaos, then keeping it together on the train. Though he has autism, he handled it all incredibly well.

So we were probably pushing it when we decided to swing by a takeout salad place for a healthy late lunch just before the birthday party.

The restaurant was pretty crowded, and there were only a few tables open. Babyboy found a small table in one quiet corner, while Babygirl found a bigger table in the middle of the larger sitting room. Both refused to relocate.

Hubby ran to the men's room while I tried to resolve the table situation. Babyboy's table only fit two, while Babygirl's was for four, so, pretty straightforward: "Let's go over there where your sister is, honey, so we can all have a seat."

But Babyboy was done. Just DONE. He had draped himself over the tinier table, hugging it, not budging.

I gently touched his shoulder and leaned down, whispered in his ear: "Honey, we need four seats, or we won't all fit, okay? Let's go to that bigger table, okay?"

He whined: "I want to sit HERE! Why does SHE get to pick where we sit when MY balloon popped and I'm sad? I should pick because I'm SAD. I want to sit HERE."

I tried reasoning, then gentle tugging. While he did release the tabletop and shuffle grudgingly towards the larger space, he did so while whining VERY loudly:

"It's not FAIR! It's not FAIR! Why does SHE get to pick where we sit? Why does SHE get to pick? I'm the one who is sad! MY balloon popped, not HERS!"

Meantime I whispered reassuringly, soothingly: "Okay, okay, I understand, here, you can watch a show on my phone. Want to watch a show? Here, let's pick a show.." I was practically begging, but, to no avail.

The more I whispered/ begged, the more he whined, and loudly. People were watching us, with curiosity and annoyance, and I was acutely aware.

When offering SpongeBob on my iPhone didn't work, I knew we would have to leave, so I announced:

"Okay, this isn't going to work. Let's go home, guys, let's go outside, c'mon. We're leaving, right now." I said this out loud, as much for the other diners' benefit, as I herded our kids out the doors.

The kids were just ahead of me, already in the glass foyer, when I noticed a loud banging and clattering sound.

It was like a fist hammering on a table so hard, that it was making the silverware clatter.

Which is what it was.

An elderly man seated near the open door was bringing his closed fist down heavily on his table, again and again, HARD, so that his food and utensils jumped and rang out with every beat.

Only when I finally looked, did he stop. He then gestured angrily towards Babyboy, raised his finger to his lips, and made an exaggerated, furious, spitting SHHHHHH sound at me.

I froze, eyes locked with this angry old man who didn't seem to speak English.

The kids were already pushing at the outer set of doors.

Only a second passed, but this is what went through my head:

Are you kidding me, asshole?  My kid's autistic and exhausted and fixated on his silly balloon and I cannot do anything about that besides leave. Can't you see that we're leaving? We've only been here about three minutes total and we're LEAVING and you have to pull this shit? 

And then I did was something I don't think I have ever done in my entire life.

I leaned towards him from the doorway, leveled my middle finger right in his face, and said, as clearly and calmly as I could:

"FUCK YOU."

Then I followed my kids into the foyer and out the doors to the parking lot. Babygirl tripped and fell and I lifted her up, pulling Babyboy along with me as I made a beeline for the car.

Meantime, Hubby had just exited the men's room. He had heard Babyboy's whining and then the banging/ clattering ruckus. He had seen the old man pointing at Babyboy and shushing us. Somehow, he didn't catch my reaction, and thought that I had just fled.

So when he passed by that guy's table, he threw out:

"Have a nice day, sir, God bless you, and by the way, FUCK YOU!" and he ran to catch up with us in the parking lot.

In the car, I was shaking, almost crying. Hubby turned to me and shared that he'd given that guy a piece of him mind. I admitted that I had, as well.

We both smirked.

Now, Hubby and I are both well-educated working folks with professional reputations to protect. As such, neither of us uses the F-bomb, or any profanities, very often. And neither of us is in the habit of losing it with compete strangers. But we did both, and if given the chance for a do-over, I'm not sure that we would have done it any differently.

Of course, we didn't do much to advance the cause. Our classless behavior didn't help anyone to understand autism, empathize with struggling parents, or tolerate tantruming children.

I'm not sure if any of that would have even been possible, but we could have acted with more grace. So, we both feel ashamed.

We did end up going to the birthday party, where we shared our story with many very sympathetic parents. People shared their own experiences of child-behavior-shaming in public spaces, and how they reacted. It was therapeutic.

Still, I know for a fact that neither Hubby nor I will ever venture into that takeout restaurant again!





Friday, March 10, 2017

The doctor self-diagnoses again (a delightfully disgusting story)

Genmedmom here.

I've posted about my own recent miserable illnesses on my own site so often lately, I'm afraid to post anything else about being sick there. People will start to think I have some underlying issue, like an undiagnosed immunocompromised state.... or hypochondriasis.

But I have to share the gross details of my latest medical problem! I have to, because it's so disgusting, it's entertaining.

So my kids and I have been SO sick this winter. There was Norovirus at Christmas, and then the flu three weeks ago (despite being vaccinated), which for me, then triggered a horrible asthma exacerbation...

But last week, I was finally feeling better. I remember thinking, "Gee, I finally feel better..."  and probably jinxed myself.

By the end of the week I was really congested and feeling run-down. "Great, a cold coming on, this sucks," I thought.

Then Saturday afternoon, I was more congested, and the mucous was really green. I felt kind of woozy, with mild chills. I ignored it and went for a four-mile run in ten-degree weather. Weirdly, it was invigorating, and the hot shower afterwards was heavenly! The mucous drained and drained.

"Ha! I beat that one!" I congratulated myself.

But, Sunday: worsening congestion, thicker gray-green mucous, facial pressure... and then there was this smell.

I smelled it first in our kitchen. A warm, dirty dishwater smell, like when you open an old dishwasher before the heat cycle is done and all that steam with the hot-moist-food-particle odor hits you full in the face. WTF? I peeked all around trying to find the source.

Then at church, I smelled it again. The kids were running around and I was distracted, so I didn't think about it too much other than, "Yuck, what's that?"

Later, at home, still soooo stuffed up, I blew my nose for the millionth time, and got a huge glob of nasty slimy mucous. For some reason, I thought to sniff it.

And there it was. That smell. It was reminiscent of when I worked part-time in our college cafeteria and there was an immense sink for soaking all the pots and pans and serving dishes in super-hot water with some kind of toxic detergent, and the clouds of steam would waft up with the odor of all those food scraps: leftover meatloaf, cherry jello, brown gravy, pea-soup, and harsh industrial-strength cleaning solution all mixed up together in one nauseating and assaulting aroma...

I realized (with a shudder) that the source of that nasty smell was my own face, my own mucous. SO GROSS SO GROSS SO GROSS!!!!

Of course I googled this, trying to figure out what was the principal bacteria responsible for this gray-green discharge with the very particular odor... No luck. Needless to say, I'm on Augmentin and I feel alot better. 


Thursday, January 19, 2017

How did you manage pregnancy symptoms at work? Share your stories!


Pregnancy is not an illness. It’s usually a joyful time in one’s life. But man, can it make you feel AWFUL. Morning sickness, fatigue, swelling, brain fog... Everyone experiences these things differently, but almost everyone is going to have something. Rare is the mom who can rosily exclaim “Gee, I felt WONDERFUL throughout my entire pregnancy!

Even in the same person, pregnancy can present differently. With Babyboy, I had very little nausea; rather, I had weird intense cravings for salty things (like sardines). So, when I learned I was pregnant with my second, I went out and bought cans and cans of sardines. Surprise! Not only did the mere whiff of sardines make me nauseated, that’s how I felt for the whole nine months.  

“Morning sickness”, which, in my experience, can last all day, is different for everyone. It can mean queasiness, or hurling. I have friends who required admission for hyperemesis gravidarum. All the ginger tea and Zofran on the planet doesn’t help, sometimes. 

I got through by only eating what I could tolerate: carbs. Sixty pounds later...

Swollen legs, incredible fatigue, brain fog... these are some of the other symptoms I experienced. I finagled "pregnancy parking" close by work at the end of my first pregnancy, when the summer heat made walking unbearable. I've heard of doctor-moms who managed to steal naps here and there... And for brain fog? I don't have any ideas what can help. 

What about you? Share what symptoms you had, and how you managed them. The info can help another doctor-mom!

Thursday, January 12, 2017

Have you encountered assumptions/ prejudice/ racism/ sexism/ intolerance/ harassment/ discrimination at work?

Genmedmom here.

Let's talk about sex, sexual orientation, race, religion, and disability, and being judged by those things, in the workplace. Have you encountered assumptions/ prejudice/ racism/ sexism/ intolerance/ harassment/ discrimination at work? 

It's definitely an appropriate political climate to be discussing this issues. Even aside from the blistering rhetoric of the past year, let's face it, for many folks, a "real" doctor looks like Marcus Welby, M.D. You know, a white, gray-haired, suited man who exudes experience and wisdom. Not that there's anything WRONG with that...

These negative attitudes can manifest differently, and span a wide range of experiences. 

The way I see it, assumptions can be innocent. These can be sort of insulting things said by well-intentioned people. They may be based in inherent bias and unconscious attitudes. Like, for example...

How many times during residency training did I walk into a patient's room, and they assumed I was anyone BUT the doctor? I was asked to clear the cafeteria tray more than once. Even after introducing myself, I was often referred to as [insert non-M.D. staff title here] and asked to fetch things: a glass of water, blankets, a urinal.

Sometimes, those assumptions annoyed me, and I acted annoyed. Other times, I tried to be cheerful and helpful regardless. I have also been guilty of making assumptions about others, and have had to retrieve my Dansko-clad foot from my mouth...

Then, there are more obviously negative/ hurtful/ damaging experiences.

During residency, a senior physician (a Marcus Welby type) whom I respected greatly and had been working with for some time chose a younger, more inexperienced, pretty unreliable male trainee to lead an endeavor that I had been interested in leading. Oh, that hurt. I wondered and fretted, Why didn't he choose me? What secret glee I felt when the young lad never followed through, and the project collapsed! Karma, man. Karma.

A woman I trained with had a miscarriage, and the supervising physicians would not allow her any time off. It was a first trimester loss. "Think of it like a heavy period," they said. "Would you call out for that?"

What I observed throughout all of my medical training was that women received very little understanding, consideration, or flexibility during pregnancy, maternity leave, or breastfeeding. The prevailing attitude was "suck it up, buttercup."

Then, I remember as a fellow, when I was interviewing everywhere for jobs. I was singled out by a senior physician (Yup, Welby again) for being half Latina. I was asked to take on a faculty position in part "because then we'll be closer to meeting the requirements for minority recruits. You can really help the department to look more inclusive. That'll be such a bonus."

That felt weird. I did not take the position.

In that job search almost ten years ago, I sought out a flexible position in a positive environment at a progressive institution, and I am satisfied that I found all of that and then some. The few negative experiences I had prior definitely informed my decision, and helped me to recognize what I didn't want as an attending.

I'm aware that many of you have had much worse and many more negative experiences than I did, and I'm wondering:

What did you encounter?

How did you manage, supercede, overcome?

What did you learn from the experience?

Do you see things getting better, or worse?





Saturday, December 31, 2016

In the dark quiet of the last day of 2016

Oh, no. Not a New Year's Resolution post. Who needs another "Live healthier, Be a better doctor, Be a better mom" post?

Well, I do.

Genmedmom here.

It's 6:30 in the morning on Saturday, December 31st, 2016, and I'm sitting typing in the quiet dark of our house. No one is stirring except for our two big spoiled cats, who relentlessly knocked things off of my nightstand until I got up.

You know how you get really busy, barely any downtime to even answer the texts from old friends, never mind call them, and all the very small spaces in your life are stuffed with overflow tasks, like making shopping lists on your phone on the train, and never going up or down your stairs without having something in your arms that needs to go up or down, like dirty laundry down and folded clean stuff up, empty tea mugs down and toilet paper rolls from the basement up, wrapped gifts down and unwrapped stuff up, so many goddamned toys and factory-new clothes and the boxes, tissue and gift bags that you can't bear to toss that will clutter your home until next year too, and even with your superior physician multitasking skills you realize you're screwing up, like forgetting to RSVP for that thing and being late paying that bill and getting lame last-minute crap for the important staff member you totally spaced out, and then even the doctor stuff starts slipping (which is always last to go, right?) like that you promised to personally get back to your longtime dear patient on a result that wasn't critical but it was important to HER and you totally intended to check that on the holiday weekend and simply send her a quick message through the online portal and you just did not do it.

Then the kids get sick, and you get sick, and any delusion of control you had goes down the toilet with the first bowl of vomit. Your Christmas agenda: poof.

Barf.

But life marches on and there's still things to do and when everyone is (mostly) better you try to keep going, get yourself and the family to rescheduled gatherings and pick up where you left off with the gifts and the cards and the outings for school vacation. Maybe you start losing track of what's really important and what's just life and lose your cool, show your frustration, yell at your kids when the situation just doesn't merit a freakout. No one is running towards a busy street or about to drink drain cleaner, they're just jumping on the couch and throwing pillows and wrestling and, well, not listening to you when you order them to get their shoes on because you're late or pick up that banana peel and take it to the trash or SETTLE DOWN already. And when they react to your red-faced temper with sass and disrespect, maybe you throw the remote control across the living room and when it lands on the hardwood with an unexpected clatter, your kids stare at you with a sad, silent combination of shock and wonder and fear that you hope you never see again.

You know you're out of balance and that this is not right and this is not you.

So in the dark quiet of a holiday weekend morning when, miraculously, there is no event planned nor pressing task nor other thing of perceived great import, you sit and breathe and resolve:

This year, I will live healthier, be a better doctor, be a better mom. I will do this by uncluttering my headspace. I will leave the little breathing spaces empty. For breathing. I will remain thoughtfully committed to my medical practice and remember the high standards I hold for myself. I will love my family, my children,  always reflecting on how blessed we are, how much we have and enjoy in this very difficult modern world. I will pray for those who are struggling and suffering, every day, I will not forget them.

Happy New Year and God Bless.

Thursday, November 3, 2016

Childcare Options for Doctor-Moms

Genmedmom here.

Childcare is such a huge issue for working parents. It can be so expensive, and it is so important. With me in outpatient primary care and my husband traveling for his work pretty frequently, we needed to figure it out.

Thankfully, we have my mom who lives close by and provides the bulk of childcare for our little ones. We have also used daycare, as well as nanny services, both to give her a break and to provide socialization for our kids.

Family help is the best, but it can't always work, for many reasons. Daycare has the advantage of providing key socialization, as well as building relationships with other working parents, a bonus that I didn't realize would be until it was. However, if we didn't have my mom to pick up our kids at the end of the day, we'd be pretty miserable. It probably wouldn't work at all.

I found nannies to be the most difficult. It was almost a part-time job to find a decent nanny, even with Care.com. And, they weren't always decent. Plus, that option can be very expensive, prohibitively so. Upwards of twenty dollars an hour in the Boston area, for a nanny with experience.

Other docs have written about au pairs, and that options sounds wonderful, but one has to have a place for the person to sleep, and we just never had that. It's a small house, barely enough room for us and the two kids. Au pair, sadly, was never a possibility for us.

What childcare options have worked best for others?

Thursday, October 20, 2016

How Do You Do It All? (i.e. The Art of Being Imperfectly Perfect)



Genmedmom here. 

Let’s face it: working moms have alot on their plate. A patient recently complained to me how guilty she felt because she couldn’t be a perfect mother, wife, accountant, and friend, all at the same time. If she felt really good and strong in one area, she was slipping in another. “No matter how much I try, I’m a failure!” she declared. 

Okay, look, despite the expectations on us, no one can achieve perfection 100% of the time. No one is going to excel in all of the areas of their life always. But we can manage. We can do our myriad jobs well enough. And we can be happy

On a weekly basis, I usually manage: four clinic sessions a week (approximately twenty hours seeing patients), one morning precepting in the firstyear medical students’ interviewing and communications course, co-parenting our two school-aged kids (with lots of family help), regular blogging on three separate blogs, kids’ dinner/ bathtime/ bedtime virtually every night, about three good workouts per week, church and big family dinner on Sundays. 

Is it all done perfectly? Hell, no. I wish I could get to all the patient phone calls, emails and lab results every week. It would be great if I could do the reading before the medical school course. Our kids are late with homework probably at least once per week. We never seem to know what's going on at school until the last minute. My blog posts often have typos, and could have used a little more editing. My workouts are sometimes really short. We don't get to church or have family dinner every Sunday.

But I can say this: We fit in what we need to fit in. We do what we feel needs to be done. It's not perfect, but, for us, it is. Imperfectly perfect. We, as a family, are happy.

I am often asked “Geez, how do you do it all?” 

Well, if what you're aiming for is happiness rather than perfection, then I’ve thought about this. It will be different for everyone, but generally, I suggest: 

Identify your time-wasters and eliminate them. What time-consuming things in your life do not help you to achieve your goals, and do not serve a healthy purpose? For me, that’s television. I do not watch television unless there is a really good reason. I’ll watch a Disney movie with the kids once in awhile, all snuggled on the couch. And, of course, once a week our whole family watches my husband’s football team play. Other than that? No sitcoms, no news, no movies. Social media can also easily become a time-sucker, so I limit that to my train commute.

Hire cleaners, if you can. Yes, we all know that we are capable of cleaning. But how much is your time worth? You are an M.D., and if you were paid by the hour, you would earn $100, at minimum. Multiply that by a thousand- no, a million- and that’s how much your hour is worth to your kids. Though we couldn’t afford it when we just started out, as soon as we could, we hired a cleaning service. They are worth every penny.

Order anything online that can be ordered online. We have groceries, pet supplies, clothes, shoes, furniture, books, et cetera delivered right to our front door. 

Stay local. Need to run an errand? If possible, avoid driving time, and support local businesses to boot. 

Schedule carefully. There are so many options for kids’ activities around us. It would be very easy to slip into driving-everyone-all-over-the-place-for-this-or-that-thing. We were forced to hold back quite a bit, as our son with autism doesn’t handle a busy schedule very well, and doesn’t do drop-off events at all. So, we have a music teacher who meets them in my mom’s home after school one day. And we choose family activities like hikes, trips to the farmer’s market, and scouting (Boy Scouts), rather than kids-only classes like dance and tae kwon do. We’ve realized that this quieter, easier, more familiar approach results in less hustle and bustle, and doubles as “family time”. 

Identify toxic relationships and avoid them. Okay, I'm wandering into therapeutic territory here, but the truth is, people who make us feel bad are a real drain on our precious time and energy. Conflict and negativity are distracting. We can't be our best selves now if we're re-living an argument or re-thinking that weird conversation from yesterday. If there's a person around who consistently brings conflict and negativity into my day, I avoid them as much as possible. Likewise, if there are good, psychologically solid people who support me and boost my mood, then hey, I want to spend more time with them.

Keep reasonable goals. I’m not striving for crazy achievements in any area. I’d like to take good care of my patients, be a solid teacher for my students, raise emotionally well-adjusted kids, keep on writing until it goes somewhere, stay as healthy as possible, and be actively engaged in our community. Like I said, it's not perfect, but, for us, it is. Imperfectly perfect. We, as a family, are happy.

What about other mom-docs? How do you "do it all?" What do you do to save time? How do you keep you and your families happy?

Wednesday, October 5, 2016

Would You/ Did You Deliver In Your Own Hospital?

Genmedmom here.

I could not have imagined going anywhere but the OB/GYN office down the hall from mine. My lovely OB was a clinical instructor in the same course as me, and I ran into her at the medical school from time to time, in between my prenatal appointments. She'd seen my cervix and God knows what else was going on down there, and yet we would find ourselves standing around pleasantly chatting about curriculum changes while sipping lukewarm coffee. I didn't care.  

Just take good care of us.

Still, with my first, I went a little psycho around delivery. I created an annoying three-page natural-no-epidural birth plan with all sorts of stipulations: no med students, minimal residents, no male anybody.

Ha. When the meconium hit the fan, there I was being wheeled into an O.R. crowded with every level trainee and both genders well-represented, and I didn't care.  

Just take good care of us.

Babyboy had to be rapidly and forcefully extracted: hauled from above and pushed from below. But he was born and he was healthy and all was good.

For my second, I had no plan. I was so traumatized by how violently OPPOSITE everything had turned out from what I had envisioned the first time around, I couldn't make any decisions at all. So my lovely O.B. firmly (but nicely) guided me through a successful VBAC.

I've seen her around since and we are very friendly. I've probably also run into multiple nurses, residents, and students who were witness to my howling hysteria in one or the other delivery, but I can't remember who was there from either so who cares.

Personally, I'm glad that I delivered with a physician I know professionally and admire. I could never have managed going to any other hospital but my own anyways, too inconvenient. 

But not everyone feels the same way. The question occurred to me: Where do OB/GYNs deliver? Do you guys generally prefer your own or a different hospital?

How about other specialties- OB anesthesia, what about you? Does it vary at all by specialty?

Maybe it just has more to do with individual comfort level with the total, supreme lack of privacy, and knowing you will be definitely be observed if not at your worst, then at least, perhaps, not at your best.

I'm very curious about this, as I am covering this topic for a doctor-mom writing project. Please, share your perspectives! Inquiring minds will want to know.


Monday, September 12, 2016

Are Mothers in Medicine Messier?

Genmedmom here.

I suspect that I'm like most docs, when I say it takes alot to gross me out.

And I wouldn't say that I'm messy, rather, I'm highly tolerant of messiness.

But this week, I wondered if maybe my threshold for disgusting is a little too high. Like, maybe there are some things so yucky, anybody should freak out and drop everything to clean it up.

Like this, for example. Check out the close-ups of the wall, soap dispenser and faucet handle:




This is our downstairs bathroom. Last weekend, the kids and I baked and frosted sugar cookies.  And, they also ate melty chocolate bars.

Both kids dutifully washed their  hands in the bathroom sink, which was left grungy with thick purple frosting and chocolate smears that then dried out.

What strikes me is that I used this bathroom every day between then and this past Thursday, and I didn't even notice this nasty crusting. It was right there, on the stupid faucet handle, that I touched, and it didn't even register with me. (Or my husband, for that matter.)

Yes, we are in survival mode most of the work week. Yes, we both have busy careers, and school just started, and our pets are demanding, and no one has a reasonable sleep schedule. But still. Honestly. This is revolting.

Is there anyone else out there who could have this palpable food residue all over their frequently used bathroom and not only not clean it, but also not even notice it for four whole days?

And, to top it off, when I saw this on Thursday, really saw it, I was literally rushing to pee before I had to run out the door to get in the car to pick up my kids from school. It was my day off from clinic, the mess finally registered with me, but I didn't even have time for a rudimentary scrub-down.

Thank goodness our cleaning people come Friday mornings...


Wednesday, July 27, 2016

Talking Politics and Public Health With Patients- Is It OK?

Genmedmom here.

My Friday morning clinic was slow. There were two last-minute cancellations and a no-show. So when Mrs. Smith* came in for her physical, I wasn't in a rush, and we had some time to chat.

We talked about her recent hip replacement, and how thrilled she was to be finally pain-free and physically mobile, so that she could help care for her grandchildren again. Her face was bright with joy as she spoke of the beach and playground and the zoo and how much she loved experiencing the world with her two young grandchildren.

But she hesitated and frowned as she remarked: "I watch the news, and with everything going on today, I worry about them. We're moving in the wrong direction as a society. I mean, look at this presidential election, isn't it ridiculous, to think that a person so flawed could end up as a candidate? I'm frightened for their future."

Then she asked, "Your children are little, what do you think about all this craziness, do you lose sleep over it too? How can we protect them from it all?"

Up to that point, we had been slowly moving through the physical exam, and I had been wordlessly responding to her lighthearted description of her days as Nana the nanny with laughter, positive nods and smiles… When she admitted her fears, I reflected back grim countenance and shook my head, as if to mime What a shame, what a shame, but I didn't say anything. 

I had no idea at this point what her specific views were. Her comments could reflect the opinions of anyone anywhere on the political spectrum. The flawed candidate she was referring to could be either Democrat or Republican. I didn't want to say anything potentially inflammatory, or even mildly awkward.

But she sat there awaiting my opinion.

Her questions hung there, between us, as I shook my head and tried to think of something to say.

Is her idea of crazy the same as my idea of crazy?

Does she want to protect her grandkids from the same things that I want to protect my kids from?

Do I really want to talk about this? And, is it appropriate?

I thought about my morning commute. There's an app on my phone that pulls articles from all the news sources I choose, and I have chosen just about every possible news source, even those representing the far other side of my political leanings. I like to know what's going on, through all the looking glasses. I read it all on the train on the way to work.

For months now, the news has been increasingly disturbing. Mass shootings, terror attacks, senseless violence against minorities and law enforcement alike, war abroad, mass displacement… it's all horrible.

But what's worse in my eyes is that here in the land of equality, in a country founded on sound principles and thoughtful discourse, we are witnessing the ugly rise of a potential dictator. Here is a divisive fascist whose behavior already mirrors that of the worst dictators in history. Historians and scholars continue to make observations and deliver warnings. This kind of a man, this kind of rhetoric, these lies and sick ideas, are what have led to genocide and war in the past. And if that isn't a public health issue, I don't know what is.

So, what do I think about all this craziness? I think about it all the time. It makes me sick to my stomach. But specifically WHAT I think about it may not be appropriate to discuss with patients. I believe that the candidate on the right is a bona fide public health issue, on many levels. But so is gun control, and beyond asking patients if they have a gun in the house and how it is stored as a basic home safety screening question, I don't get into the issue with anyone.

Perhaps we should. Perhaps we, as educated professionals with a sworn oath to promote the health and well-being of our patients- ALL of our patients- should be open about our views on matters that effect patient safety. Maybe that could be a means of educating the public on important issues, like gun control.... and rhetoric that promotes violence.

This all went through my mind...

So, what did I say?

I murmured "I know, it's really scary…", paused and smiled and declared, cheerfully: "Your grandkids are so lucky that they have you. I'm so happy for you that the hip surgery had such a good outcome."

She smiled back, and we went on as if nothing at all was wrong with the world.



*Patient identifiers such as social history and medical issues altered.

Monday, May 9, 2016

What does it really mean to be a mother in medicine?

As in, in real life, day-to-day, down and dirty?

Genmedmom here.

I'm working on a writing project about being a mother in medicine in practice. This is going to be the everyday stuff: the logistics, the scheduling, the practical aspects, the balancing, the conflict. Funny stories, lessons learned, suggestions, and mistakes.

As I was thinking about this project, I realized that my experience in clinical practice is drastically different from women in other specialties. There's no way I can write this without input from moms in every area of medicine!

Things I was wondering about:

When I was pregnant, it never occurred to me not to tell people. I can't keep a secret to save my life. But I have colleagues who kept their bumps hidden for as long as humanly possible, for many different reasons: worries about discrimination; fears of being passed over for promotion; superstition. What did folks out there do? If you felt like you had to hide your pregnancy, how did you, and for how long? Looking back, what do you think, was it necessary?

What about those specialities where there is risky occupational exposure, I'm thinking radiology, surgical subspecialties… How did you manage that in pregnancy? If you needed to step out of the room, how did your colleagues react?

A lot of doctor-moms don't take a full three months of maternity leave. Some take more. Does this vary a lot by specialty? Did folks feel pressured to take less than three months? Did anyone have to fight for three months?

I never pumped at work. (Long story.) For the moms that did, can you share some of the good and the bad? Were offices and hospitals supportive or not? Were facilities acceptable or not? What were your worst pumping experiences? Would you do it again?

As a general internist with no inpatient duties, my call weekends involve, well, phone calls. What is it like for doctor-moms who have to go in? For the surgeons and anesthesiologists out there, is it better to be on call from the hospital or from home?

My office clinic is low-key enough that if I need to, I can step out and answer a phone call from my kids' teachers or the school nurse. But what about for moms working in the operating room or the ICU or on a busy inpatient floor? If you need to step away to take care of your family, are you supported?

My husband travels, and occasionally, I've had to cancel a clinic day to stay home with the kids: blizzard closed the schools, kids throwing up… Have others needed to cancel their workdays for childcare? Did colleagues make you feel bad, or did they step up? For those who haven't or can't, how do you manage those unforeseen events, the school cancellations and nasty illnesses?

I am eternally grateful that I can work part-time. I know that not all physicians approve of that. For those working full-time, how do you make that work? What supports and systems need to be in place for you?

And of course there are more questions, more scenarios… We can all learn from each other!
All specialties should have representation. I would love to hear what you have to say.

Don't feel comfortable commenting here? Email me: mauroratello2@gmail.com


Wednesday, May 4, 2016

Quality Time: What Is It, and How Can I Create More of It?

Genmedmom here.

Typical morning clinic day: I'm up at 4:50 a.m. and out the door before 6 a.m. to catch the train. The commute is prime time to skim the news/ blogs/ email/ social media, or, order groceries for delivery. I arrive at work early to prep charts. My patients are scheduled from 7:40 a.m. to 12 p.m. (and clinic usually runs over). Then, it's patient calls/ prescription refills/ results/ all kinds of paperwork/ maybe some writing until somewhere between 4 and 6 p.m. Then, I run for the train, ride back, run to my car, pick up kids at my mom's. Wrestle kids out the door, stuff them into the car, and herd them into our house. If Hubby is not working or traveling, we make a good effort to sit down to a nice dinner, usually warmed up leftovers from a weekend pot of soup. We tag-team on the evening stuff: get kids to eat if they haven't eaten, feed the cats, unpack schoolbags and yucky lunch boxes, identify any major school communications or homework, make lunches for the next day, wash dishes. The kids start getting super-silly and disobedient around this time, so I cattle-prod them up the stairs, out of their heinously dirty clothes, and into the bath; attempt to wash their hair (which usually has food in it) and yell at them for splashing water all over the place. Get kids out of tub, then chase after them as they actively evade me, giggling and taunting. Pull pajamas on, force them to brush and floss teeth, read books. Read more books. Read JUST ONE MORE BOOK PLEASE MOMMY?

Sigh. By the time the kids are asleep, I'm exhausted, and I realize with great sadness that I've spent most of our precious few hours together yelling, nagging, scolding, threatening, and counting to three about fifty times.

The few minutes we have snuggling in bed reading quietly (well, truthfully, it usually stretches into thirty minutes reading quietly) is the only real "quality time" we've got.

I know there are doctor-moms out there with busier schedules than mine (I only work four days a week).

Busy doctor-moms, how do you create quality time with your kids? What does it look like? When do you fit it in?

Thursday, April 7, 2016

When The Doctor Is Sick, Again

Genmedmom here. Coughing, coughing, coughing. This is the third respiratory thing to catch me in as many months. Damn germs, can't get away from them.


I'm apologizing to everyone: my husband, for waking him up all night with my uncontrollable hacking; my kids, for my medicated and exhausted attentions (or lack thereof); my patients, for spewing my droplets about the tiny exam room; my fellow commuters, for daring to get on the train sick.


I'm following all my own advice. I know I've got cough-variant asthma and I'm on top of the Albuterol. I'm taking Dayquil and Nyquil, and snarfing tea with honey and endless Ricola.


But still coughing, coughing, coughing. No fever, non-toxic, I'm eating and drinking and walking and talking and parenting and working and COUGHING.


Not sick enough to call out; miserable enough to want to.


Docs, what do you do?


Never mind, I know the answer. Suck on my inhaler, take Dayquil and Nyquil, snarf tea with honey and endless Ricola, and suck it up.





Monday, February 29, 2016

Because I Hated Every Second of Breastfeeding

Genmedmom here.

There have been many times when I have struggled to empathize with the patient. There are certain healthcare issues, and certain patients, that I have found consistently frustrating over the years.

I've written about this, and been pretty well chastised by readers. I don't mind, because I know that 99% of physicians have their kryptonite issues, and just don't talk about it. I'll take the heat for being honest.

My kryptonite issue has been obesity. I admit, that for many a patient encounter, I've sat there and counseled (for the millionth time) on diet, and exercise, and priorities, and wondered to myself: Why can't you do this? Why can't you just lose weight?

I know that sounds terrible. Heck, it IS terrible. My bias is based on my own experience: I gained sixty pounds in my first pregnancy, and fifty in my second. The weight didn't come off postpartum, and I found myself obese. BMI 30. I dedicated what precious little time I had as a working mom to eating healthy and exercising, and I lost it all. It took two years. It was hard. There were ups and downs. I've written endlessly about it here, and here, and here....

Of course I know that it is totally and utterly unfair to think "Well, if I could do it, why can't you?" but truth is, that's a pretty natural way to think, and many of us think like that.

So I've been making a conscientious effort to do better, to let go of the bias, and the frustration, and meet people where they are, no matter what the medical issue is.

But it was only when I was sitting with a lovely young patient of mine who was upset, grieving, actually, that she had been unable to breastfeed her infant, that I had a real breakthrough.

This poor woman had had a complicated pregnancy and delivery. Nothing had gone the way she had planned. But she held on and held it together, because she knew that if her baby survived, she would do everything right. She would take THE BEST care of this baby. She was determined to breastfeed for a full year. It had never occurred to her that that might not happen.

There were problems with the latch, with the milk supply, with pain, with baby's growth. Still, she was determined. She got the hospital lactation consultant and a private lactation consultant and every breastfeeding book on Amazon and drank Fenugreek tea et cetera, et cetera... for weeks.

But one day when she had spent an hour and a half with the industrial-grade pump and got only about a teaspoon of breastmilk, with her nipples raw and bleeding, with her infant screaming, starving, with the pediatrician's concerns about his growth, with her consultants saying "Just push through! Keep trying!" for the gazillionth time but without any other real suggestions, and without any progress, she broke down.

She gave up.

So the baby got formula. And did fine. And grew. And she thought this burden was lifted from her.

Until the judgments came.

She was part of a social circle that especially valued breastfeeding. Friends and family would comment, say, "Don't you know breast milk is best?" or "Well, if you had only tried X, I bet it would have worked" or "If you had only HUNG ON a little bit longer" or "Those doctors pushed you towards formula, those doctors always push the formula, you shouldn't have listened" et cetera, et cetera.

It got to the point that she hid bottles and formula, or avoided socializing altogether. She felt like a freak, a failure. She worried what awful consequences there might be for her baby. She waited for some severe illness to befell her son, and for someone to blame it on her.

Oh, my heart went out to her.

Flashback. I was pregnant with Babyboy (now five and a half years old). I had a three-page birth plan outlining my natural vaginal delivery. I had a doula. I had Ina May's books on childbirth and Nancy Mohrbacher's books on breastfeeding. I had secured a highly-rated lactation consultant and booked a consult with her BEFORE the baby was born. I bought Medela breastmilk bags and a plastic organizer for the freezer. I arranged a breastfeeding room in my office.

But there were complications. The delivery- that's a story for another day. Emergency C-section for deep transverse arrest. Bradycardia. Meconium. Mayhem. I was discharged with a hematocrit of 22.

Babyboy was fine, but I grieved the loss of my dream birth. I was determined to get breastfeeding right: I wanted to breastfeed for a full year.

But. There were problems with the latch, with the milk supply, with pain, with baby's growth. I was still determined. I got the hospital lactation consultant and a private lactation consultant and every breastfeeding book on Amazon and drank Fenugreek tea et cetera, et cetera.

Miraculously, I was able to breastfeed for a full three months.

But, I hated every single second of it.

When it got close to feeding time, I would inwardly cringe. With his latch, I would outwardly gasp, and clench my teeth in pain. The doula and the lactation consultants gave up on me. It was a nurse practitioner at Babyboy's pediatrician's office who suggested APNO (All-purpose-nipple-ointment), and it was an OB/GYN who prescribed it for me. The APNO cream helped a bit, and it got me through the three months, though nothing really helped.

Inevitably, what would come to mind with EVERY feeding were images:

Of glass-shard covered twine being pulled out of my breasts through my nipples.

Of someone pouring acid over my areolae.

Of my baby with little piranha teeth and malevolent intentions.

Oh, I hated it, and I hated myself for hating it. Wasn't breastfeeding supposed to be this wonderful bonding experience? I would rock and cry, literally cry, while stroking my baby's forehead and begging forgiveness, because I could not WAIT for this to be over.

So when it came time to go back to work, I started on a combined oral contraceptive and took Benadryl, and let that milk supply dry right up. Worked like a charm. I was done. It was such a relief.

When I told my colleagues I would not be needing that breastfeeding room, I got some eyebrow raises, but no one questioned. Many of them had made similar decisions for different reasons.

Most of my friends were understanding (very different social circle from my patient-mom) and for that I was very grateful. As a matter of fact, people came out of the woodwork with their own breastfeeding difficulty stories. I was not only NOT the only person who had struggled, I was not the only person who hadn't enjoyed it, and I was not the only person who had guilt about that.

Yes, there were a few "judgy" moments. People I didn't know well, and luckily didn't give a rat's ass about. A lady at book club gathering, a friend of a friend.

But my patient, my poor patient. Her "support network" was annihilating her. I was outraged on her behalf. I wanted to reassure her.

So I shared my own story with her, and we discussed ways to manage the hurtful comments and avoid the negative people.

For doctors, sharing our own stories and feelings about medical issues with patients is a tricky thing. Sometimes it's appropriate, sometimes it's not, and sometimes it's a mixed bag. In this case, the patient expressed relief and gratitude. She had been initially expecting me to judge her, too, she said. She was so glad to have found validation, reassurance and open discussion instead.

That's when I had my breakthrough: The patient had been expecting me to judge her, and had instead found validation and reassurance.

Wow. THAT is what I need to bring to EVERY patient encounter. Validation, reassurance, open discussion. Because that is what I would want for me, as well. It's what I want to be able to provide for everyone, especially my patients.




Wednesday, February 10, 2016

Vomit, Poop, Snow, and Chlorine: A Week In Review*

Genmedmom here, venting.

It's just been one of those weeks. There was no one particular event. We're fine, we're (mostly) healthy, we're happy.

But, it was just one of those weeks.

I was on call for our practice last weekend. Now, our weekend calls are not that bad. We do not round on inpatients at our hospital anymore; the hospitalists care for our patients. There were not that many pages.

But, the pages came at odd hours, and in bunches. Sleep was totally disrupted. There were stressful moments. Then, we have a brand-new, very complex electronic medical record to content with. I struggled with ordering prescriptions and documenting… Again, nothing big, just, annoying.

Then, Sunday afternoon, Hubby started having nausea, and chills, and muscle aches. Ruh-roh!

Yup, we were in for it. One by one, we were felled by the GI bug. Hubby had a mild version Sunday. Minimal active GI symptoms, but, down for the count. Overnight Sunday, Babyboy started spewing. I was on bucket duty. God love him, he never missed the bucket.

Monday, Tuesday, Wednesday, all clear. Long days at work: twelve-plus hour days, mostly immersed in this new computer system. But, no one was sick at home. We all breathed a sigh of relief.

Then. Thursday evening, I started feeling a little queasy. I vasovagaled in the kitchen, caught myself. I went to bed early, wracked with nausea, chills, body aches. I considered calling in sick for Friday. But, I wasn't actively spewing, I just felt like crap.

I debated: There was going to be a snow storm. Going to work in a snowstorm is bad enough, but feeling ill, would be even worse. On the other hand, calling in sick meant I would have to contact the few early morning patients myself, to cancel. But, these patients may be canceling anyways, given the snowstorm... I just couldn't decide, couldn't even deal. It was easier to just suck it up.

Friday morning, 5:30 a.m. I shivered into the shower, bundled up in wool, and headed down. I brewed the coffee, but I couldn't stomach it.

It was just starting to snow. The driving wasn't bad. I drive to the train, and take the train into the city. For the first time since pregnancy, I had to sit down on the train.

Now, I hate when healthy, able-bodied, lazy-ass people take up seats that others may legitimately need. I felt ashamed for sitting, but at the same time, I didn't think anyone would want me passing out onto them, either.

At work, I had plain Earl Grey tea to ward off a caffeine- withdrawal headache. The snow came down. Most patients cancelled. My stomach actually settled. I felt better as the day wore on.

Friday night at home: After I picked up the kids from Nana's house, where they had spent their snow day largely outside, they helped me help shovel out our neighbor. It was after dark, and cold, but they couldn't get enough snow. I was just relieved to be off-call and feeling normal. Whew! I'll get some better sleep tonight, for sure! I thought.

Then Babygirl vomited on the couch.

Babygirl vomited multiple times. Despite strategically placed buckets and towels, we had to change her bed out entirely, twice. She stopped vomiting abruptly at about 11 p.m. and declared that she'd like a glass of water, please. She downed it, and another, and was fine the rest of the night.

Saturday morning, this morning, we were supposed to have a behavior therapy group session with a new family. Babyboy is mildly autistic, and needs help interpreting and managing a lot of social situations. We were supposed to bring Babygirl, too.

We debated. She'd been spewing the night before, but had awoken bright and cheerful. She had wanted warm milk. She drank it, and it stayed down. She was playing, she was smiling.

We decided to take her.

Bad call.

Ten minutes into the session (at another family's house, people we had never met before) she vomited. She managed to warn us, and we managed to get her to their bathroom, but it all ended up on the floor. I cleaned it all up, on my hands and knees, apologizing right and left.

Then, right afterwards, Babyboy had a poop accident. He's five and a half years old. We've been working on toilet training for over two years now. We'd just had a week and a half without a poop accident, our longest stretch ever. We thought maybe, just maybe, he's toilet trained!

Nope. Hubby took care of this mess, in the same bathroom. The family was so kind and understanding, but still. We were so embarrassed. You could smell it for the rest of the session: rancid milk vomitus, foul stool reek.

The kids were supposed to have their first swimming lesson today, as well. It was out of the question for Babygirl. I envisioned her vomiting in the YMCA pool… Good God. No way. Hubby took her home to watch endless Peep and the Big Wide World, all wrapped up in her pink blankie on the couch.

I took Babyboy to the Y. It was his first swimming lesson ever. I was nervous. He was nervous.

It didn't start off well. We walked into the locker room labeled "Family Locker Room". It was packed and bustling with half-dressed men and kids of all ages and moms with babies and SO MUCH NOISE in such a small space… There were changing booths with curtains on them, but I could not remotely imagine getting myself undressed and into my bathing suit, separated from the men and young boys by a flimsy curtain.

But Babyboy made the decision first: "Mommy it's too noisy in here, please let's GO…" He had his hands over his ears like they hurt, overstimulated to a painful degree.

So I took him into the women's locker room with me. We had already changed into our bathing suits when the YMCA police (or whoever she was) came in and informed me that children under eighteen years of age aren't allowed into the women's locker room. At all. Ever. And we had to leave. Now.

The lady was very stern, and Babyboy started to cry. He thought he was being scolded.

"Listen", I pleaded. "I just don't feel comfortable in that Family locker room with all those men and boys around, you know?"

The lady relented. "Well, you can use the Girl's locker room, if you like. Technically, it is for girls, but, he's pretty little…."

And so we did. Apparently, there were no girls of an age that would use the Girl's locker room around, because it was completely empty. We relocated, stuffed our winter gear into a too-small locker and entered the pool area.

Whoa! The pool was super-steamy and the chlorine odor was almost overpowering. I wasn't sure if Babyboy would be able to stand it, but he did. Other than the fact that he slipped and fell on the tiles, requiring a helpful lifeguard to get him an ice pack for his head, Babyboy enjoyed his first swim lesson, such as it was. He wouldn't get in the water without me (I had anticipated this) and there were several other special-needs kids, plus, it's the Y, so of course it was a little scattered and chaotic. But, it was fun, and he was more comfortable in the water at the end then he had been at the beginning.

Back at home, we all laid low the rest of the day. We drew, we read, we watched Peep.

Now, we sleep. I hope…

---------------------------------------------------------
*This post was written Saturday evening. Sunday morning, our longtime pet cat passed away unexpectedly. The kids were brokenhearted. We were brokenhearted. Obviously, that event overshadowed all of the crap I've complained about here. I decided to let this post stand, however, because it's how I felt at the time. I wrote about our kitty on my own blog: The Biggest Pain In The Ass Cat You Ever Could Love: We'll Miss You, Raffy