Showing posts with label JC. Show all posts
Showing posts with label JC. Show all posts

Friday, July 13, 2012


The clock is not the enemy.
Fatigue is not the enemy.
The hospital is not the enemy.
Consultants are not the enemy.
The lab is not the enemy.
Utilization review is not the enemy.
Your patient is not the enemy.

DISEASE is the enemy.

Go forward with courage ladies.

Sunday, January 1, 2012

In the Air

On December 26th a helicopter went down in Florida, taking the life of a heart transplant surgeon, an organ procurement technician and the pilot. Although the donor heart could not be used, the intended recipient was fine and awaited another donor match.

I heard the news through a text message from my on-call partner, interrupting me two stories into the bedtime routine with my 3 year old son. “A helicopter went down going to get a heart.” The heart transplant community is a small one, this news hit close to home. Often these procurement missions include multiple transplant teams (i.e. heart, lung and abdominal) with young surgeons in training riding along. I often send my fellows or students and have gone myself.

On a rainy night in September I drove along a narrow road on the far side of the airport. I was looking for the private hangar, and once I arrived I pulled into an empty parking lot. There was a dim light on inside so I grabbed my bag and headed for the sliding glass doors. I stood in front of the door and waved my hand but the sensor was not on. I knocked and a handsome man in a flight jacket walked over and let me in. I told him I was part of the transplant team and he looked at me skeptically. I wondered if I should have identified myself as “doctor”. I was the first one there so I sat in the waiting area and helped myself to some coffee and spiked it with hot chocolate.

The last one to arrive was our heart transplant surgeon. With the team complete we carried gear to the awaiting plane. The supplies were placed in the cargo area, but the cooler would ride with the passengers. I lifted it into the cabin, I noticed it was light and empty. As the heart transplant surgeon grabbed it from me his gaze held conspicuously on my belly. Even wearing scrubs I could not conceal the fact that I was five months pregnant. He then climbed out of the plane and practically lifted me up into my seat, he was sure that I did not miss a step.

Once we were strapped and secured into our seats I studied his face and could tell there was something on his mind. I met his glance confidently and smiled slightly. He shook his head, “Do you know how dangerous this is? An entire team from Michigan was lost a few years ago. You know, I am a pilot for fun, and know a lot about aircraft. These guys are good, really good I make sure of that. You must always insist on safe transport. Never go in a prop plane and never let them take you in a helicopter.”

I took in his advice, committing it to memory. As we taxied in the darkness my mind considered the precious cargo including 2 pilots, 2 attending surgeons, 2 fellow surgeons, organ procurement specialist and myself. Then I thought of my patient that we were leaving behind, in the CCU on a balloon pump desperate for a new life. Finally, as we sped down the runway and I felt the first few bumps of flight I placed my hands on my belly and said a little prayer. To the hands of God I give the battle for life, miracle of healing and trust in His protection. The only tragedy that evening was the untimely death of our donor whose family gave the beautiful gift of life.

As the details of the accident in Florida unraveled I learned that I did not know the individuals involved. Not personally. But the event awakened the reality of how close we dance every day on the brink of life and death. Upset, I asked my husband to finish the bedtime routine and retreated to have a short conversation with my colleague. He summed it up perfectly when he said, “This job is humbling…. in so many ways.”

Friday, June 24, 2011

The MiM curriculum

One morning last week, I was standing at the mirror in the gym locker room getting ready for the day. In the corner of my eye I saw a person scurry past. I recognized her immediately. I was excited to see a familiar face, yet she disappeared before I could say hello. When I peered around the corner and she was nowhere to be found, I realized that she was likely avoiding me. Not really a good practice to stalk someone in a locker room, so I turned away. Then as I blow dried my hair the conversation that did not happen played out in my head.

She is a cardiology fellow. Mother of two. I know this because her children are the same age as mine. She breast fed both babies. I know this because her co-fellows teased her about it at the end of the year roast one year ago.

She was hiding from me because I am an Attending. She did not want to be seen at the gym at 8AM on a work day. She fears that she would seem lazy, less dedicated or selfish.

What she needs to know is that I am so proud of her. One tough mama taking all of her call, doubling up while gravid to trade days to allow a maternity leave. Finding a way to be an equal to the guys without being one of the guys.

I would like to tell her that making time to exercise squeezed between early morning mommy duties and full time fellow work is an enviable feat. That what you have done, is perhaps one of the most important tasks you can do to ultimately ensure your success. Yes, I know it is not in the cardiology fellowship curriculum. This lesson really should be Chapter One of the MiM curriculum. Stepping out of the role of mother and physician to see yourself is crucial. By recognizing your need and fulfilling it. Because it means more than just finding time in a busy schedule. It means making time, trading off that early morning conference or sneaking in a little late to read echos. Whatever. Over ruling what is expected of you, to recognize what is actually best for you. A brave move that will make you stronger at the core.

And of course, I would never utter to another soul that I spotted her at the gym. Dear, your secret is safe with me.

Wednesday, May 11, 2011

Pregnant in the cath lab

There is no harm in being protective of your unborn child. There is no harm in speaking up for yourself when you have strong feelings about any subject. For heaven sakes we are in a healing profession- we should take care of one another too. We should make a pact- all MiM and MiM followers to steadfastly protect and promote the (physical and mental) well being of our gravid counterparts.

There is potential harm in overstating the risk of x-ray in pregnancy. At least from my perspective. Sorry for additional post Fizzy, I have too much to say for comment section. I really think you are on to something here, and I appreciate this discussion.

First to get this out of the way, there is a major difference between therapeutic (or diagnostic) radiation exposure vs. occupational radiation exposure. All physicians would consider using x-rays to examine or treat a pregnant woman. As long as the benefit outweighs the risk. Do you need dental xrays while pregnant- probably not. You have a serious condition during pregnancy, attempts will be made to use alternative imaging or minimize fetal exposure. The risk to the fetus is based on amount of exposure (may vary based on type of exam) and week of pregnancy. It would be a mistake to x-ray a pregnant woman without considering the fetus (therefore the questions and signs in radiology). Just because there are signs and attempts made to avoid exposure in no way means that it is absolutely contraindicated.

Here as Mothers in Medicine we are discussing occupational exposure. A classic intersection of personal responsibility and professional obligation with undercurrents of gender discrimination. We would all take a bullet (literally) for our children, our own safety/sanity is only a secondary concern. What are we willing to expose our children to- now that is a hot topic.

Fifty percent of Internal Medicine residents are women, yet only 14% of all cardiology fellows and a mere 7% of practicing cardiologists are women. We may be few, but as women in cardiology we are a serious bunch- and are concerned about why more women do not consider careers in cardiology. It is likely women are deciding not to pursue cardiology early- as med students or interns. Concern over lifestyle and radiation exposure during mothering years is likely a key issue.

Tackling the subject head on, two important papers are published in cardiology journals. The first published in JACC in 1998 ( is a consensus statement for radiation safety in the cath lab. This year another consensus statement ( ) was published by a group of women interventional cardiologists (now these are women who I seriously admire). I recommend that you read both if this issue affects you directly.

Here are important points I would like to make:
1. Fizzy's initial post upset me a great deal, it felt like a personal attack (unreasonable I know). I think this points to how intimate and heart wrenching pregnancy related issues can be.

2. Fundamental radiation science: exposure is proportional to energy emitted, inverse to distance from source, and subtracted by protective equipment. When pregnant I wore two layers of lead (my usual apron) in my first trimester then special pregnancy apron (even though it weighed 12 lbs-or maybe a TON) the rest of the time. I never let the fellows control the fluoro pedal and when able always took an extra step away from the camera. On occasion I took it as an excuse to stay far far away from the table, on a stool in the corner where I could rest my feet too, a bonus.

3. When I was a fellow one of my female attendings was pregnant. It really helped me to see her in this role. She gave me the best advice. Meet with the University Radiation Officer- this really helped to balance my fears with what is known about the risk.

4. The female fellows in my current program are not allowed to work in the cath lab during pregnancy. This takes the decision making away from them. I am not 100% behind this, only because it is really hard for them to find coverage for maternity leave already.

5. X ray is not the only source of radiation exposure. I learned from the Radiation Officer that my greatest risk would be during my nuclear cardiology rotation. Patients dosed with isotope emit radiation, and despite high standards areas of radiation can be present in the department. Always wear your badge when reading nucs, do not leave your lunch in the reading room and for heaven sakes do not do injections for stress tests or PETs.

6. The total amount of radiation allowed in pregnancy is 0.5 mSv per month and 5 mSv for entire pregnancy. This is 10% of the amount of radiation defined as negligible by ACOG guidelines (Obstet Gynecol 2004;104:647–651 ). Studies from diagnostic radiology in pregnancy show exposure below 50 mSv is not associated with fetal loss or anomaly. Other population studies suggest that exposure to 100% of the allowed radiation during pregnancy will increase the risk of having a child with congenital anomaly from 4.0% to 4.01%. The chance your child will develop cancer will increase from 0.07% to 0.11%.

7. It is difficult for me to compartmentalize my role as mother and cardiologist. It all runs together in an overwhelming way. Eight weeks pregnant, while taking progesterone for a fetus at risk I was inches away from the camera while doing CPR on a woman while my partner inserted a temporary pacemaker. I had lead on, but had not yet declared my pregnancy and did not yet have a fetal badge. That woman celebrated Mother's Day with her children last weekend. During my 2nd trimester I was exposed to acute viral myocarditis, amazingly 3 times where two of the three patients were killed. Suspected viruses can cause fetal hydrops. The surviving patient was a miracle and my ability to cure him was instrumental. My team knew I had ID consultation and special tests by Employee Health. They did not know I took a "time out" in the call room where I sobbed uncontrollably for 20 minutes.

I carried two pregnancies and worked in the cath lab both times. I checked my fetal badge religiously every month. Under my lead, over 18 months of pregnancy my fetal badge (s) summed total radiation exposure of <0.01 mSv, below the measurable limit, ZERO.

It is probable that women avoid their true calling into cardiology due to concern over the occupational hazard. It is possible those who do pursue cardiology still face additional obstacles based on current maternity policies (I think this is true of most of medicine). My experiences thus far have been challenging, and I hope we can make things better for the next generation.

Okay so you may now jump in to discuss. So let me have it, I imagine being crucified and accused of child endangerment. For the sake of full disclosure in addition to exposing both of my boys to radiation I also ate lunch meat, non-pasteurized cheese and even drank a glass of wine (or two) during my 3rd trimester. And if anyone corrects my writing/ grammar I will kick your ass.

Sunday, April 3, 2011

Will pee for M&M's

My 2-year-old son is learning to pee on the potty. When I ask him if he would like to go to the bathroom, and he shouts M&Ms!! In our small community you will find a similar response from all toddlers, it is nearly universal. A behavior modification tactic, the children are offered candy as a reward. At our house it is one for sitting on the potty, two for peeing and three for poop... although we have not had any "poops" yet.

To the best of my knowledge this stems from a popular pediatrician group that many families use. It was the doctor that suggested this positive reinforcement system- of course with the reminder to always brush your teeth!

This has me thinking about how our practices influence the populations that we serve. Especially when it comes to non-evidence based measures, where personal style has an influence and regional preferences may exist. I can think of a couple of examples from Cardiology. For one stress testing. When selecting an exercise or pharmacologic stress you may choose your imaging modality. Depending on the strengths of your lab you may favor echocardiography or nuclear imaging. Personally I prefer stress echo because you can look at the valves and diastolic function (sans radiation), but you must have a great tech who can skillfully scan the patient as they hop off the treadmill. Another example is the management of acute MI (heart attack). Depending on where you live the standard may be primary PCI (going to the cath lab) or if you are in a rural area thrombolytics (clot busters). Also when in training the way we were taught seemed like the obvious and natural way- but then when emerging into practice there were some real surprises.

As far as I know (the little-people docs out there can set me straight!) the M&M potty training protocol has not been subjected to a randomized controlled trial. It probably just worked for my pediatricians kids- and so will it for the rest of us.

Now for the next challenge, his teacher says that he is ready for underwear at school. So our bag is packed for Monday- Elmo undies and extra pants for accidents!

Tuesday, December 14, 2010

No balance on the crazy train

I must admit, work- life balance is something I lack.

To be honest balance was a problem for me before marriage and children- well before earning my MD and before I took on the responsibility of caring for extremely sick patients.

I can remember in high school rushing home from basketball practice to work on the lay-out for the school newspaper. With copy and photos spread across the dining room table I would stay up all night long until it was perfect. In college I would sometimes sleep in the laboratory in order to run experiments, even on the weekends. Because of the fear that my work would not be good enough this super human dedication provided comfort that at least I would not fall short in effort. My extreme personality served me well in residency and fellowship, and I excelled.

This is my nature, and honestly this behavior had some consequences. Over the years I learned to accommodate or “tone down” these tendencies. In personal relationships, I realized my expecting perfection was alienating (and annoying). I learned that diversification was necessary to achieve balance, so I included exercise and relaxation in my schedule. Over the past few years I recognize that these changes are working for me. I find that I am happier and more effective through letting go, and exercise continues to be a good outlet for stress.

Fast forward to now, and although a recovering perfectionist I constantly battle feeling overwhelmed and exhausted. Right now I am not working, at home with my 6 week old son. I am determined to use my return to work as a fresh start. I have been soul searching trying to figure out what changes I need to make. This is difficult. One obvious problem- I am not working at all and still feel exhausted and overwhelmed. Not unusual for a new mom, and expected based on the irregular sleeping schedule. But as I review my spiral notebook full of lists I have created…… feeling frustrated that I am unable to make much progress on the multitude of tasks…. I wonder if this is hopeless. It is a similar feeling that I experience when working, with so much to do and unable to achieve the momentum to get to the bottom of the list.

Seriously I need help. From others I know that the first step to work life balance is learning to say no….. but why is this difficult for me? My problem is not saying no (I can be really tough when necessary), my problem is being able to discern what tasks are valuable and which are not.

Tasks that are not fun or productive but nonetheless necessary: Just because it feels like drudgery does not mean that it can be skipped.

Tasks that cannot be left undone (someone else must be found to cover): I would rather not do it, but is it worth the trouble to finding someone else? Maybe I should just get it finished already.

Tasks that are opportunities with potential strong upside: These are the easiest to say no to (many of my male colleagues would jump at the chance) but why must I pass on opportunities that I have earned?

With reflection and soul searching I realize my old tendencies are possibly still at play here. That an underlying personal expectation for perfection and fear that my work would will not be good enough still plagues me. I am afraid it is true, and despite significant personal and professional achievement I still rely on external measures of success. I now believe that this is at the heart of the matter. I hope this is the beginning of my next personal transformation…… but still at a loss for how to overcome this hurdle.

I figure that I am not alone- for the ability to withstand numerous years of training and tolerate long hours must commonly be motivated by similar ‘dysfunction’. What is the secret to better discernment? Any advice from those who already figured out how to disembark the crazy train, or from others riding along with me?

Tuesday, October 26, 2010

AWOL: Waiting for baby

I left work four days ago. Standing waiting for the elevator I felt tears well up in my eyes. Pushing back the emotion I turned my thoughts away from reflection and toward my next move.

A 38 week and 4 day little boy. Inside my uterus threatening to make his big arrival. Oh the places this little guy has gone (conferences in distance cities, organ procurement midnight travels) things he has seen (dying patients, miracle recoveries) and the drama overheard (dying great-grandmother, father unexpectedly unemployed). I could feel the strain of the pregnancy. In my hips and pelvis. On my mind. Being the wholesome expectant mother was inconsistent with my reality of 12 hour work days, two week blocks of call and Saturday and Sunday rounds.

It was time for me to move on. To move away from my office. To enter the parking garage and drive away. To pick up my two year old at day care in the middle of the afternoon. To arrive home in time to make dinner.

Really I had made it. Worked beyond emotional and physical pain. Accomplished professional milestones that I felt would justify my absence for maternity leave. But on that day instead of high fives on my way out- I felt a strong sense of disappointment. Despite all that I had done. Despite my sacrifices of health and happiness. To my (mostly male) colleagues at the end of that day I was still leaving. Taking a three month "vacation" where my work would need to be done by someone else.

Is it simply a scenario of wanting the cake and to eat it too? (And let me tell you I have indulged in my share of cake eating over the past nine months.) Honestly it would have been my preference to continue working up until my due date. To ease out of the most grueling work and ease into my transition home. Ultimately I had to call it quits. I needed a physical separation. I needed a vacation.

In my first days home I completed my patient charting, painted/organized the nursery, caught a matinee and napped in the mid-morning (and afternoon). It has been an active process of turning off my role as doctor, grappling with this guilt of desertion. What I have been able to do is sit and find my voice (hence the blogging). A week ago I feared that labor would come too early- leaving me to scramble and find a replacement for my hospital duties. Now I find myself, thank goodness waiting patiently, staring over at an empty bassinet as I type.

What I also found is strength. Strength that I was using every day, but somehow managing only to get by. Following a day at work too exhausted to climb the stairs to bed and overwhelmed to the point of tears. Now physical strength to attend a fall festival and join the family for a hike in the woods. Emotional strength to participate in the hospice care of my grandmother occurring five states away. Finding myself in the quiet and recognizing that there is plenty of me for this baby, my son and my husband.

Yes I do have a problem with work/ life balance. Partially to blame is my chosen specialty, but also to blame my own ambition. Achieving a sustainable effort is something I will continue to pursue- but for the time being I am the wholesome expectant mother. Hmmm, I wonder if there will be time for a pre-natal massage before my OB visit tomorrow afternoon?

Monday, October 25, 2010


I attended medical school from 1996 to 2000. At that time HMOs were on the rise, Google was being born and a strong emphasis was placed on patient autonomy. Although no one recognized it at the time, we would become the next generation of physicians. We had already been advised by old wise doctors to choose another profession. That we would never make any money. That MDs were no longer respected by society, and everyone (insurance companies, litigators) were out to get them.

We enrolled in med school anyway. We would become the physicians that knew nothing other than evidence based medicine, that would trade in our pharmacopias for epocrates, and see a work hours revolution change how patients are cared for in the hospital.

As an impressionable first year medical student I had a wonderful course called Medical Humanities. In a series of lectures we explored the philosophy of doctoring, and received our assignment. To preserve our humanism despite the rigors of training. To see each patient as an individual. To ask open ended questions. To respect cultural and racial diversity. To evolve beyond the paternalistic model and embrace the world where the patient is a partner.

I took this assignment on as a mission, reminding myself as years went by that smart and skilled was only part of the equation. That acting patient and compassionate was ultimately important. Years later I find myself in a field caring for extraordinarily ill patients, where astronomical efforts are made to save a life. Where more often than not this falls short and the best we can offer is a good death.

Over time I sense something that is just not right. It began with overwhelming frustration as a patient arrived with a ream of "medical information" downloaded from the Internet. Later it turned to disbelief as I found that my patient who cannot afford their rent is buying $100 per month of vitamins and supplements. As I find myself explaining why their information and supplements are bunk I find myself tip toeing in order not to offend and alienate. With so many new sources of medical information I think perhaps the grumpy old physician was on to something, the role of the physician has changed. Not necessarily a lack of respect toward doctors, but certainly a fair dose of skepticism that perhaps is deserved.

In my opinion the partnership model became derailed as the physician embraced the evidence and at the same time grew fearful of litigation. Informed consent then became central to the patient- physician relationship, a legal document. The conversation turned to odds of this and that, alternatives A and B, and finally the decision is up to you. The physician no longer answers the age old question, "If I were your mother/ child/ spouse what would you tell me to do?" Instead the doctor deflects a personal stake in the matter and ensures that in case of a bad outcome it will all be supported by the evidence, guidelines and paperwork.

Emerging from my medical training I began to feel an alienation at the bedside of my sick and dying patients. Witnessing their struggle with fear and uncertainty I felt like the care was falling short. The paces of a typical hospitalization includes selection of the proper evaluation, declaration of the correct diagnosis, and the discussion of treatment (with risks and benefits)- by the book. All of this done with the physician as the advisor and patient as a partner. When tackling the toughest issues- for instance at the end of life this series of discussions and decisions became just too much.

Grandma is too ill to speak for herself and there is a 80% chance that she will die. Would you like for us to do? Continue to try to save her? Should we treat the renal failure/ pneumonia/ UTI? Place a feeding tube? Continue lab work? Continue IV fluids? Turn off the ventilator?

My attempts to impartially advise and educate about all options grew in conflict with an urge to protect. To comfort. To spare whatever suffering could be spared for the patient and their family. But to step in and dictate what should/ could be done would be adopting the age old Paternalism we were raised to leave behind.

Perhaps there is a better way. May I be bold and call it "Maternalism". A way to provide compassionate care and resume part of the burden that we were taught to deflect. Partnering not as an equal but as a nurturer and comforter. For dying Grandma, first to help the family understand the situation, then to articulate what Grandma would have wanted. If that is go down fighting, they get a fight. But prevent the fight gone awry where Grandma suffers years as a vegetable with a feeding tube. If Grandma wanted to die naturally, then we allow nature to take its course. But spare the family from the agonizing series of discussions, where the family feels that at each step they are actively bringing the death of their loved one.

I find myself in a struggle to practice with excellence but also to sleep at night. Perhaps what we need is a sound clinical trial- or perhaps a meta-analysis to investigate the most effective role of the physician- in the post-Paternalistic era?

Thursday, March 25, 2010

"AMA- Advanced Maternal Age"

Dear MiM,
What things did you wish you had considered before having a baby during residency? Are there any moms out there who had children after residency or who were unable to get pregnant after residency (b/c of advanced maternal age) that have regrets?

Ob-gyn resident from the Bay Area, California

Dear OB/Gyn resident:

Let me start off by stating a simple truth that we all refuse to accept. We are not in control. This was made painfully clear to me only following the dismantling of my perfect plan for having a baby.

Married a week after med school graduation, my husband and I chose not to start a family during residency. We struggled with the initial adjustments to marriage and work, and instead of having a baby had a fantastic time eating out, drinking and traveling. Looking next toward cardiology fellowship, time for baby needed to be in the plan. My first year focused on survival. The second year I volunteered to make the master fellow schedule. A small sacrifice of negotiation + mediation to have control of my own schedule. I stacked my call and cath lab months in the first half of the year. I found a research mentor and agreed to a extra year research fellowship. It would be perfect. November was my last month in the cath lab. Pregnant in December. Start research in July. Have project off the ground, maternity leave in September. With some luck I could extend my research a third year and have number 2!

In reality I was diagnosed with anovulation due to PCOS in April. I then became a fanatic triathlete. By the time I started my research fellowship I was exercising 3 hours a day and was skinny as a rail. I figured I could be the 'best' PCOS patient ever (so it seems PCOS is NOT all about adipose/obesity after all). Fertility drugs in the fall leading up to my first miscarriage. Then a freak accident leading to a broken arm, ORIF in January. Crazy girl running on the treadmill with my arm in a sling. Hip pain, months of physical therapy. Diagnosis of acetabular tear, second to underlying congenital hip dysplasia. MDs doubtful I could walk during a pregnancy. Hip surgery the next January. So by the time I spent 2 years trying to get pregnant and 6 weeks on bedrest following my hip reconstruction I finally said, I give! I get it. I am NOT in control and I cannot make what I want to happen- happen. Not even with a superwoman effort bordering on obsession!

And well, as it turned out it is not too hard to get pregnant. Not hard at all when you are not working, resting, reading, watching TV all day- all while on *bed rest*!

Finding the right time to have a baby is difficult for Mothers in Medicine. You have read on this blog about the challenges of managing maternity time off and negotiating with colleagues the pre-occupations of a mother. The consensus is that no time is the perfect time. In my experience, finally understanding/ appreciating the amazing gift of a healthy pregnancy made all accommodations more palatable. My story is not unique, the complicated world of the female reproductive system has it's quirks. My practical advice to you: take care of your marriage, take care of yourself. When both feel good have a baby. Because in reality we are not in control. Letting go is often required for us to find the future we desire.

Tuesday, March 23, 2010

Day Care Drop

How do you manage day care or school pick-ups, drop-offs, holidays and sick days for your children? My husband is a surgery resident so he can't drop my daughter off (he leaves the house at 5am), and most days even if he *thinks* he may be able to leave early, something inevitably comes up and he can't leave as planned. He sometimes can get a day off to care for our sick daughter, but he certainly can't do it every time she's sick. I know there shouldn't be a difference between MiMs and FiMs (Fathers in Medicine) but hey, I think the reality is there is a difference. Just curious.


Bea is married to a PGY-2 surgery resident and writes a blog about medical marriages and her experience thus far.

Thank you for the question Bea.

When I headed back to work after my maternity leave I was surprised to find how pre-occupied I was (constantly) with this very issue. Working mom's may seem busy with the task at hand, but a small part of their attention is always dedicated to the child(ren). During my day there is a second schedule (not included in my outlook). It includes a series of toddler activities: reading time, art projects, music, lunch and nap. As I move through my day I am thinking about my son and what he is up to. As the day winds down this turns into an obsession watching the clock. A real MiM fear, getting caught up with a sick patient and not able to be there for your child.

The day care is a wonderful place, overall. A little less wonderful is the yellow highlighter they use on the classroom sign-in sheet. Ten hours per day, maximum. That seems like a long day for a one-year old. It is a blink of an eye for a Cardiologist. Drop off at 7:30 AM, pick up at 5:35 PM..... violation! Marked in fluorescent yellow for all of the parents in the class to see. Oh the judgement and guilt served by that mark!

My husband is not a Father in Medicine, but he is a Corporate Executive where the majority of his colleagues are married to women who do not work. We try to stagger the drop-off and pick-up so that we can each work a full day. The game plan however, is altered more often than not leading to a frequent race against the clock.

I hope others will chime in and add their creative solutions, depending on your specific situation there may be a novel idea that could be applied. In our house, salvation recently came in the form of Miss Kim. She is a teacher in my son's classroom, and he LOVES her. She is single, and lives between the school and our house. She now "picks up" for us, bringing my son home from school. Sometimes they stop at the park, other times they rush home to take the dog for a walk. She feeds him dinner. Now my husband and I arrive by 6:30 with a happy and fed little one. We then spend the next two hours relaxed, fully engaged in the bedtime routine.

Another strategy for me, our University has Major and Minor Holidays. The Minor holidays being those where school is out but most work places are open. If we work the minor holidays we receive an extra vacation day. I have my admin block all Minor Holidays- Out of Office. It is my Mommy prerogative. That way it is set up in advance, and I am not scrambling the week before to cancel clinic or find child care.

Then for those rare days, when my day is a short one and I can greet the little man mid afternoon. The best is making it for "buggy time" at 430, when the kids are strapped into the multi-kid stroller. Carrying my son around the block while the others ride, taking in part of his day- I am on top of the world.

Wednesday, March 3, 2010


When I was pregnant with my son (now 15 months) I sat down with Dr. Sears' book. I probably did not fully grasp the true philosophy of attachment parenting. What I do remember is one statement in an early chapter that disturbed me at the time and haunted me since.

I remember reading that mothers who work full time and take time off for maternity leave have a high risk of attaching poorly to their babies. That instead of completely focusing on the role of mother they instead are preparing for the day they will leave the child. Preoccupied with their career they are unable to be fully responsive to the needs of the child.

I am sure many reader's blood is boiling right now. Now if I have mis-quoted Dr. Sears I apologize, but even if I did my real point is this: I think about this all of the time. When my son was a newborn and would not nurse, my sleep deprived hormone toxicated brain determined it must be because I planned to pump when returning to work. When he did beautifully with the transition to day care, I figured he didn't really miss me. When he runs to daddy when tired, I take it as further evidence of my shortcoming.

This is working mommy guilt and as a Mother in Medicine I did not invent it. Upon reflection I think overcoming this thinking is a unique challenge for the following reasons. First, I sacrificed a remarkable amount of sleep, happiness and personal well being to become a cardiologist. The idea that I could continue to sacrifice in a way that I would later regret is a true possibility. Second, in reality if I had to choose either my career OR motherhood it is not 100% that I would have chosen motherhood. This is perhaps difficult to explain but I feel like my work is a calling that I was born to do and is my mission in life. Finally, I am a master organizer/ planner. Indeed I was pre-occupied during maternity leave planning my return to work. But only because of my deep respect for how challenging it was going to be- and my desire to arrange help so that I could enjoy my son (an hopefully not kill anyone in my mommy-head state).

So I put this out there to share how my consideration of attachment parenting led to a judgment that is difficult to shake. The challenge to be a mother, as a full time physician, as a perfectionist, as a woman committed to caring when it seems no philosophy can be easily applied to my reality.

Friday, February 26, 2010

The Journal Backlog

I recently experienced an epiphany. In my office I keep a stack of journals (most still in the plastic wrapping) that I plan to read. Instead of reading I cultivate this neat pile, that is about to sprout into a daughter stack.

Then I did the math:

Journal American College of Cardiology (one/week = 4/month)
Journal Heart and Lung Transplant (one/month)
Journal Cardiac Failure (one/month)
Six journals/ month or 1.5 journals per week!

Epiphany: unless I ACTUALLY read at least one journal per week the pile will continue to grow.

Despite the new clarity I have yet to read or recycle.

It true Mother in Medicine fashion, and in the spirit of full disclosure, I present another pile. In my kitchen, of parenting magazines. Nestled neatly next to my stand mixer (which I am proud to report has been used quite frequently lately).

Sunday, December 13, 2009

My day last Wednesday......

A day as mom, wife and the cardiology teaching attending.

0603 Baby cries, out of bed. Husband gone to gym. Labradoodle wagging tail.

0635 Hug, kisses, clean diaper. Labradoodle pacing nursery.

0640 Oatmeal, applesauce, milk. Coffee for mom. Labradoodle watching expectantly.

0655 Wipe hands, face, high chair, floor. Labradoodle helpless, softly barks by door.

0657 Labradoodle returns from outside, excited for treat.

0700 Dad home from gym, Labradoole showers him with licks. Mom in shower.

0735 Find baby, Dad and doodle in playroom. Mom in dress and heels crouched in miniature chair to read book. Baby loses interest at page three, moves on to puzzle.

0755 Out the door. More coffee. Granola bar.

0805 Remind myself I should not be reading Blackberry while driving

0825 Park, walk past gym (boy I need to exercise), up to office

0830 Glance over desk multiple stacks of papers to beautiful view of water

0835 Sit down at desk, more coffee, sign charts, read emails, work on manuscript

0930 Don white coat, pack pockets with stethoscope, name badge, article to share with team, lip gloss

0935 Take deep breath, push metal plate button, mechanical doors open. Here we go. Heels clip, enter Cardiac Intensive Care Unit. Vents wheeze, telemetry beeps. Long coated residents and short coated students assemble. Post call team members look weary. Start rounds.

0940 Review angiograms, echocardiograms from overnight admissions. To the bedside.

0950 Find mother with 20 year old son. New diagnosis of heart failure with uncertain prognosis. Attempt to convey seriousness of situation while allowing for an element of hope. More rounds.

1020 Team met by transplant patient taking new heart out for a lap around nurses station. Supported by physical therapists and with husband in tow, she pauses to give me a high five.

1040 More rounds.

1055 Grouchy man irritated that he has not had breakfast, and is waiting to go to cath lab. Attempt to diffuse his anger and reassure.

1115 More rounds.

1130 Patient with elevated neck veins, muffled heart sounds, low blood pressure. Review clinical diagnosis of cardiac tamponade (I am genius cardiologist/teacher).

1140 Patient with large pulmonary embolism, yesterday I was certain it was left heart failure (I am idiot cardiologist/ teacher).

1200 Urine nicotine positive on patient who requests heart transplant evaluation. Confront him about smoking. He denies. Without heart he dies. Cardiology fellow asks, “Wouldn’t you lie too in his situation?” I suppose if I were stupid enough to smoke with end stage heart failure I would be stupid enough to lie.

1230 More rounds. Post call intern looks miserable.

1245 Patient returns for the third time in 4 weeks. Could not afford his medicine.

1300 Last patient to see, of course not on the floor. March team to echo lab. Find patient. Finish rounds.

1330 Retreat to office for salad and almonds. More coffee. Dictation and charting.

1400 To pathology lab to review heart biopsy specimens from last week. Discuss with partner immunosupression for complicated patient.

1435 See clinical research study patient for exercise test. She sets new record on treadmill after artificial heart operation.

1500 Administrative meeting with Nurse Practioner to review clinic schedules, insurance pre-authorizations, upcoming travel to conference.

1615 Back to CCU to check on sick patients. Talk to families again. Confirm plan with nurses and fellows.

1730 Back to office, already sky is dark beyond window. Unpack lab coat pockets, transfer items to purse.

1745 Walk past gym (boy I need to exercise) drive home

1815 Pull into driveway. See Dad, baby and doodle down the street in a cluster of neighbors.

1817 Tackled by doodle who escapes from leash to greet me

1820 Pre packaged dinner into oven

1830 Back to floor with baby who is already in PJs. Books, puzzles, balls. Sing if you are happy then you know it.

1855 Upstairs for diaper, rocking chair, lullaby and bed

1910 Dinner out of oven. Defrost veggies. Glass of wine.

1940 Dishes, laundry, organize house.

2030 Climb into bed. Catch up with husband.

2100 Asleep

Wednesday, September 16, 2009

Please don't mention it.

The Day Care topic day is scaring me a little. Okay scaring me a lot. I am mother to a 9 month old. Since birth- well actually earlier- even in the womb my son was the happiest little baby. When carrying him, he was not much of a kicker. Granted on my feet running around all day it was hard to be conscious of his movements. I would lie in bed at night, holding my belly, waiting to feel him move. Nervous I would often put the heart echo probe on my belly, just to see the heartbeat. Turns out he is just an amazingly chill baby. Coming from a mother who is, let’s say less than chill, it seems to be a bit of a miracle. As a newborn he loved to sleep. He rarely cries. He loves to cuddle, giggle and follow the sound of the labradoodle’s jingling collar from room to room. My friends are envious of how “easy” he is. He makes us look like excellent parents. So, yep he is perfect and now it is in my hands not to screw it up! The fields of motherhood are treacherous. For this working mom no area more frightening than the topic of the care of my most precious during the day while I am at the hospital. It comes up all of the time. Casual conversation in the elevator, with patients who see me again after pregnancy leave, from colleagues with genuine concern. So how is it to be back to work? It must be so hard to be away from your son. Do you miss him during the day? Did you hire a nanny? Does he go to day care? No matter how I answer these questions I ALWAYS feel terrible. The honest truth? Maybe I was excited to get back to work. Maybe I am so engrossed in my patients my mind rarely wanders home. I must be a horrible mother. I must be a terrible human. Evenings and weekends we celebrate the little man. I am constantly observing his progress. He seems to be doing fine. So far. But I still worry. It seems that if my baby is happy, successful and loved it is good, right? Good enough?

Sunday, August 30, 2009

Gotta start somewhere

They told me over and over again. Don’t let get sucked into too many commitments. Stay away from committee servitude. Learn to say NO! I was listening, really I was... but no woman-in-medicine can truly prevent another woman-in-medicine from making the mistakes that perhaps need to be made to learn for ones self.

This is my rumination as I walk the several block course across campus to spend the afternoon wasting away on a thankless large university committee. Making matters worse the temperature is 100 degrees, 80% humidity (why did we want to live in the South?) Packed between my office (within the ivory towers of Heart and Vascular) and the administrative fortress where I am headed there are, I kid you not, six fast food restaurants. Who would ever need to eat a 1/3 pound beef burger, covered in roast beef, jacked up with liquid cheese and dipped in au jus? Since when did they start selling KFC and Taco Bell in the same building? Exactly what does it smell like in there, I cannot even imagine. It is lunch hour and cars are wrapped around the drive-thrus. I am a heart doctor, I see patients who need heart transplant. These are the sickest and youngest people adult cardiologists take care of. Seriously I think America is completely unconscious of what we are doing with food. Granted my position is from an extreme perspective- recent Weight Watching, point-counting exercise worshiping alertness. It is so hard (seriously as working mom or anyone) to navigate healthy choices for regular meals. Working people will rush over lunch hour, eat a 1400 calorie value meal, finish without pause, lack satisfaction and ultimately feel hungry four hours later. It is so easy, almost necessary, but a trap that so many people are stuck in. Finally arriving at my meeting I find the provided lunch, deep dish pizza and chocolate chip cookies- just wonderful.

Few hours later I survived the session- and have a one track mind headed to Subway for a 345 calorie 6-inch sub. I am behind a tall 350 pound man in line. He looks at me, smiles and shares, “It’s my birthday I should get what I want but I will be good and choose a salad.” He then requests the sandwich maker to go light on the lettuce, add two scoops of tuna salad, cheese, pickles and extra thousand-island dressing. Waiting patiently for my turn in line a grin sneaks across my face. The birthday boy and struggling young cardiologist share a moment, and I recognize the lesson offered to me. As with my slow progress learning to say no, you’ve gotta start somewhere.

Thursday, August 27, 2009

Guest Post: Introducing JC

I was proud of my husband’s decision to go with the avocado sashimi over the fried spring rolls for the first course of our Sushi dinner. Having a cardiologist-wife has its benefits, being spared from major dietary intervention with LDL cholesterol of 186 is not one of them.

As I used my chopsticks to make the perfect bite (avocado, jicama and wasabi sauce) our conversation digressed to a famous argument we suffered at a Maui grocery store, circa 1998. As a medical student I was invited to present my research at a conference in Hawaii (score!) My then MBA-student-boyfriend took an 18 hour flight to spend 48 hours with me at Kapalua. When shopping for dinner he really wanted an avocado. I was alarmed by the price- SIX dollars, which was roughly 53.5% of my allotted per diem. They scare you at med school orientation, warning that every dollar you spend you will have to pay back three once interest accrues. He had a strong case, traveling so far, avocado would taste good with fresh pineapple, yada yada yada.

We could not remember who won the argument. Years and many jobs later we have come a long way. Earlier in the day without flinching I bought a $200 pair of jeans. If you saw how awesome my 9-month post partum butt looked in them you would totally understand. For sure it was an unusual occurrence. Wandering into a boutique we were met by a designer blond in 4 inch heels. I knew I was in the right place, but still had no idea of what I was doing. What is up with the sizes anyway? Feeling the need to explain my complete lack of style: stroller pushing, no make-up, pony-tail, Teva sandals mess. OK here is the deal- I spent the last 12 years wearing scrubs, had a baby, lost a lot of weight and my trainer told me it was time for skinny jeans- and so here I am.

So at dinner, let’s just say I was feeling about as fabulous as a 35-year-old mother could. And to sweeten the deal- as a party of 2 ½ we got orange wedges and fortune cookies for three.

My fortune: Generosity and perfection are everlasting goals

JC is our newest contributor to Mothers in Medicine and will be writing here regularly about being an academic cardiologist and mother. Welcome, JC!