Showing posts with label KC. Show all posts
Showing posts with label KC. Show all posts

Monday, June 24, 2013

Pump hero

I needed to meet with a team to grade their students and had set up a time to meet them in their team room. This is one of the best team rooms we have in the hospital. It's spacious, with a wall of computer stations on either side, and windows lining the opposite wall from the door, filling the room with natural light. When I'm bringing the third-year students around to their team rooms after orientation, I always deliver this team's students last since it's kind of like closing the curtain between first class and coach.

I walked into the room and saw a medicine intern with her back to me, working at her computer. At the other wall, the senior resident was reading some papers before him. They greeted me as I sat down with my folders and took out my forms for grading.

"I hope you don't mind, but I'll be pumping while we do this." In the sudden quiet, I heard the telltale rhythmic sounds that I knew so well. She was pumping. Right there. In the team room. I didn't notice earlier, but she apparently had a hands-free set-up going, and was typing away, doing her notes. I glanced back at the senior resident, nonplussed. This was routine business.

I was filled Admiration. So impressed.

"I think it is so awesome that you pump in the team room!" (Could I have?)

"I've lost all modesty after 9 months," she said with a smile.

We graded. She finished pumping, cleaned up, stored the milk, and I could not stop smiling.

Saturday, June 1, 2013

Mother's Day, MiM-style

Mother's Day this year was my favorite one to date. It involved working for 7 hours at the hospital, so maybe my expectations were low that it would be one for the record books. (I had traded teams with another attending in order to get the weekend before - daughter's first communion - off, but that meant being on for Mother's Day.) Instead, I was pleasantly surprised.

8:00 am. Enter post-call team's room  - an all-woman team with resident, 2 interns, and 1 third year medical student - bringing breakfast (nothing worse than being post-call, hungry, and not having food) - and I'm met with a chorus of "Happy Mother's Day!" None had families of their own yet, but they knew about mine. Before we launched into patient presentations, they wanted to know about how my family fun 2 K run went the day before since I had warned them that if I didn't show up that Sunday, it would be because I had died from attempting to run that thing (Not a runner. Usually break things when attempting to run.) We round, take care of our patients. I write my admission notes and head home.

4:00 pm. At home, Girl (8) and Boy (5) have prepared a Mother's Day show. Boy2 (2) is an unpredictable assistant. There is a ticket booth with tickets and an information sheet informing us that we should expect to arrive between 4:00-4:15pm and the last time to get there is 4:15pm.

We all go upstairs into Girl's room and me, husband, and our awesome au pair M are seated in a row of office and desk chairs facing Girl's bed. She reads from a script.

"Ladies and gentlemen, boys and girls, before we start the 3 songs, I would like to talk to you. Over there near the bounce area, you can get raffle tickets. There are only 27 raffle tickets. You just ask for a number of tickets, I hand them to you, you sign your name, and hand them back. Then at the end of the show, I will pick the winner, give them artwork and they will keep it. I also have artwork for KC because it is Mother's Day. Now, if you are wondering where the bounce area is, it is there. (points to corner with many random pillows and blankets). You cannot get all the tickets. The most you can get is 6 raffle tickets. Boy, '1' please."

Boy runs to the CD player and starts the first song of the Holiest Kid CD Known To Man, a CD given to Girl by her first grade teacher at the end of last year - very holy bible songs in surprisingly catchy tunes - this CD deserves a post in itself. Girl, Boy, and Boy 2 stand on the bed and sing and perform. It is achingly cute. (and holy).

"Thank you, thank you. (bow)" repeat x 2 other very holy songs.

At the end, I won the raffle AND got special Mother's Day artwork. Score!

"The show is over. You can play on the bounce area or leave. Thank you for coming. You can also take one of the dolls on the floor, but not Rebecca or Baby Boy, they are my favorite. Thank you!"

7:30pm.  I am walking into Verizon Center arena with Girl for her very first concert. Taylor Swift. This is a birthday present for her, but I am secretly very psyched. It's been ages since I've been to a concert. Girl is a Daddy's girl through and through. I'm usually assisting our boys (very much Mama's boys) and the husband, her. This time with her feels very special. She is BEYOND EXCITED. Half walking-half running ahead to find our seats She screams and sings along to the songs. Watching her experience the concert fills me with joy.

Taylor Swift is fantastic. Such a great, entertaining show. The best concert I've ever been to by far. (OK, maybe not saying much given my track history - not telling - but let's just say the concert that's a distant second was Madonna's Blond Ambition tour, complete with her torpedo bra outfits. Much less family-friendly.)

11:00pm. We finally get home after the drive in from the city (and leaving before the encore - tomorrow is a school day) and get her quickly ready for bed. It's going to be a rough morning.

It was a full day, a  day of work-life on steroids. And completely awesome.

Wednesday, May 15, 2013

And many more

In honor of Mother's Day, I was interviewed for Radio Rounds about Mothers in Medicine - why it was started, how it's grown, and whether I thought mothers in medicine could "have it all." (An enthusiastic Yes.)

Mothers in Medicine will turn five this month - 5 years of stories from amazing women who I am honored to write with and share this space. Some have been writing here from Day 1; others have joined in along the way. All have shared openly, these thoughts and feelings that could easily be kept private, for the benefit of this community. The blog's growth has been staggering.

This blog is still my favorite "extracurricular." I list it on my CV under "Service to the Community" because I think that's what it is: service. It's community. A labor of love. And definitely, not a business (note: we do not, nor will we ever have ads. Advertisers, please stop emailing.).

So, MiM writers, thanks for writing. You are all fantastic, and I still hope for the day that we'll hold a MiM conference somewhere tropical. I'm buying you all drinks. MiM readers, thanks for reading and commenting and liking and sharing. You're why we are all here.

To 5 years and to many more.

Wednesday, May 1, 2013

Less than perfect

I admit I’m not a perfect mother.

I wish at the end of the day, I can see all the bathwater that has sloshed out of the tub and likely making its way down cracks in tile and through the subflooring, and not angrily bark at the kids (who are at least in the tub and getting clean). After I bark and they are settled into their beds as I read their bedtime stories, I imagine how I could have handled it differently: with less anger, more love, and more humor.

I wish I could make them do things that they don’t want to do without the aid of bribery or sheer parental authority force. Like being creative and using Jedi mind tricks. Like being a positive shaping force instead of a strong-arming wet blanket. I manage to do this well sometimes, and others…well, I default to those methods which take the least time and energy.

I wish I could always be 100% attuned to them and their needs when we’re together, instead of being preoccupied with what I’m doing on the computer or the laundry or the person on the other end of the phone line. I realize this sometimes only after they raise their voice to tell me something again. Or act out to get my attention.  This always makes me feel guilty, vowing to try harder.

I wish I could put aside all of my stresses – and there are many big ones I deal with every day –when it comes to taking care of them, instead of letting those stresses spill over messily into my precious family time.

I have friends whom I think are better mothers. I imagine: what would she do in this situation? Or how would she handle this? Probably with more patience, I think. Less frustration, most likely. More accepting, I bet. This helps me be better in the moment, or sometimes the moment has unfortunately passed, but I’ll try to remember for next time.

I’m not a perfect mother. I’m a work in progress. But, I hope my children know how much I love them, and how much I think of my own imperfections, so that one day, we all could not be prouder of the mother I have become.

Posted originally on

Tuesday, March 19, 2013

Women leaders in medicine

Last week, I went straight from the hospital to the Washington DC Convention Center for the AMSA National Convention. I was there to receive the 2013 Women Leaders in Medicine Award, along with 4 other women; part of the award reception was a panel discussion on the significance of women leaders in medicine. We had received some questions to ponder ahead of time that the moderator would ask us, and then it would be open to the floor of mostly women medical students.

The award came as a total surprise. I had no idea who had nominated me (nominations came from medical students across the country), but was excited to hear that we would be each introduced and a brief excerpt shared from the nomination letter. I’ve been really proud of my career so far, but after seeing who my co-award winners were and the list of prior award winners (including Surgeon General Regina Benjamin and former CDC Director Julie Gerberding), I was feeling a tiny bit which-one-of-these-things-is-not-like-the-other.

I was up first, alphabetically, and the excerpt mentioned how well I’m able to balance an academic career with motherhood. My internal response: Well, I’m glad it seems I’m balancing it all! I guess it always feels like a work-in-progress to me. It’s always “trying to balance” and not, “Oh yeah! I’m balanced!” But, if I can send a message to others that doing both – having a successful academic career and family life— is achievable, then I’m glad.

The other award winners were Carolyn Clancy, head of the Agency for Healthcare Research & Quality; Sophie Currier, the woman who took on the NBME to allow time during the exam for nursing mothers to pump (she won!);  Petra Clark-Dufner, Director of the Urban Track at U Conn; Laura Tosi, orthopedic surgeon and director of bone health at Children's National Medical Center.

We represented a spectrum of ages and stages in our career, and I think this made the panel discussion richer since we complemented each other. We talked about leadership – how there’s not just one style but a range, and how you need to find the style that works for you. Sometimes, it’s about standing up for what you believe in, despite the consequences. Sometimes, it’s being the first and paving the way for those behind you. But, it’s also about caring for those you lead. It’s about being generous with your talent and time, and putting the needs of the people you lead ahead of your own: to help them grow.

We talked about mentors, and how you need to look beyond the traditional 1:1 model of mentorship – those traditional models are rarer today –you may have many mentors, people who can offer you pieces that will help you with the whole. And, great mentors may be actually peers, perhaps within a few years of you. Don’t be afraid to approach someone you admire and ask them for their advice or time. The worst they could say is no – and we need thicker skin than that.

We talked about challenges as women in medicine, and what we did to overcome them. For some, it was being the first, being a rarity: a female orthopedic surgeon starting many years ago. I thought having children was the biggest challenge I had faced – from  the guilt of leaving work at a reasonable time to catch my daughter before bedtime, to the mania of pumping.  My solution: I wrote about it. I also started MiM to form the community I wish I had around me (at the time, none of my colleagues had kids and didn’t really understand).

One question from the audience was, "Do you have any regrets?"  None of us did in terms of what field we chose to go into, and I didn't think I had any until I remembered one incident where I assumed people knew I wanted a certain position. I was too modest to directly voice my interest in the position, but many told me I was a shoo-in for it, and I believed it would happen. I wanted it to happen. However, I didn't get it, and when I finally had the nerve to ask why, I was told, "You wanted that? Why didn't you ever tell me? I thought you weren't interested." I was devastated. And I learned to be vocal about what I want. If people, your supervisor, those in positions of power, don't know what you want, you're unlikely going to get it.

One woman asked what would we tell our younger selves? I couldn't think of an answer to this off the top of my head, but did remember we did a topic day on this way back in 2008! (See here and it starts a few posts down: The advice we wish we had in medical school; just re-read mine and agree 100%.)

Another asked, "What's the one piece of advice would you give you women entering medicine today?"
Answer: Do what you love. We can’t predict the twists and turns our career path will take when starting out, but following what you love is the way to having a fulfilling life and keeps you going. There were several themes along this line. The room got quiet and I, who had been silent for this question, said, "Marry well." The room erupted into laughter. But, I explained that my decision to marry my husband (sitting there in the crowd, now getting slapped on the back) was the best one I had ever made for my career and otherwise. Without someone in your corner who supports you, who is an equal partner in life, it's going to be very difficult to succeed in both spheres. (I'm not the only MiM who has said this!)

Our last charge was to leave the audience with one final piece of advice. I said, "Follow your passion," which fulfilled the pithy criteria I was thinking was most important, but now looking back, I wish I had said:
We women need to stick together. We need to support each other. We need to come together and celebrate what makes being a woman in medicine special. We need to lift each other up.

Thank you for being here, lifting each other up.

Thursday, July 19, 2012

Hard, but worth it

I love being a medicine attending in July. It's often more intense work since everyone's in a new role. Bright, fresh interns. Excited new R2s and R3s. And the medical students- the new third-year students who have toiled in the classroom finally get to focus on patient care. Their enthusiasm over hearing a mitral regurgitation murmur, over watching a paracentesis, and, well, their enthusiasm over everything, is infectious. Perhaps it's a bit of a vicarious thrill to be re-living that excitement again  - the realization that we have such a privilege to care for patients and to make a real difference in their lives, of being empowered by knowing and understanding, and being consciously aware of our own growth as physicians. As a medical educator, July is a highlight of the year. Hard, but worth it.

On a recent weekend day, I was rounding with my residents and students. Working on the weekends is my least favorite part of attending on the wards. These are days that belong to the family unit; I always feel an anticipatory dread leading up to a weekend work day. Of course, once I'm there and working, it's all about teaching, about patients, and it goes by quickly.

Well on this day, I had finished rounds with the team, but had something important I felt I needed to do before I could leave for the day and catch up with my family. There was a patient whose struggle with his illness had moved me, and I wanted to make sure he knew I had heard him, that I understood. So, I wrote something for him: his story, as told to me, as received by me. Not his History of Present Illness, mind you, but his real story - his loss of his identity due to his illness. This was his suffering I needed to acknowledge. I asked him if I could read something I wrote him.

That moment, of reading those short few paragraphs, was filled with light. There were tears. There was an opening of wounds. There was sharing - so meaningful and real and deep -that it nearly blew me away. Nine years of being an attending and I am still able to be blown away by the absolute honor of doing this work. It didn't matter that it was the weekend. That I was at work. I was simply filled with gratefulness for this moment and for the job I am so lucky to have.

It's moments like this that remind me it is entirely worth it, weekends and all.  It is a gift.

*This patient gave me his permission to share this moment.

Tuesday, May 15, 2012

Parenting in medicine mentoring panel

I just attended the annual Society of General Internal Medicine conference - a conference that always inspires me. You can tell the values of an organization from its meeting. SGIM is understated (no commercial sponsors or huge pharma-dripping exhibit hall) and the work presented is largely focused on health disparities, improving the health of our society, and education. The opening plenary session was titled "Does the Moral Arc of the Universe Really Bend Towards Justice?" (The answer was a heartening yes.)

One of the sessions I attended was a Parenting in Medicine Mentoring Panel, a wonderful idea with an unfortunate acronym. Nancy Rigotti, who directs the Office of Women's Careers at Harvard and a past President of SGIM, led the panel. Mothers in medicine of various stages of their academic career shared their stories, much like we do here. There was also time for questions in the packed room of mostly women and a handful of men (including one division head who spoke about his support for work-life balance in his department by budgeting maternity leaves and family leaves, into his yearly FTE equation, and contracting with emergency child care services- awesome.)

Some key points that were made by panelists and the audience:
  • Being a physician makes you a better mother. That quality of being calm under pressure comes in mighty handy when you’re faced with a teenager who announces, “I didn’t go to school today.”
  • Make your partner a partner. Many women echoed this. Some split the weekdays in terms of who was responsible for making dinner for the evening
  • Get help to do things you don’t want to do to spend that time with your kids. If you can afford housecleaning help, it is worth it.
  • If you find yourself working in an unsupportive environment, find a peer group who all have kids to help cover each other when needed.
  • Take risks - in your career path, in life
  • There is no one way to do it. We each find ways to make it work with our families and choices.
  • Don't delay having your family. Unintentional childlessness or having fewer children than desired happens to mothers in medicine.
  • On-site childcare can be a godsend.
  • Make family dinners a priority.
  • Share our stories, form communities of support. (See: MiM byline)
Finally, this thought was shared: Kids are a gift, not an achievement. In all of these ridiculous Mommy Wars and trying to decide who is doing it better, why not just focus on the gift?

Friday, February 10, 2012

Listen to Susan

As I sat at the funeral of a friend this past week - a brilliant former NASA astrophysicist and mother to two sweet boys, 5 and 7 - I felt the collective reverence emanate like an aura over the pews for a woman who was truly extraordinary. Susan and I met through blogging years ago and though we were writing in a medium that engaged distant audiences, we happened to live within miles. For as long as I knew her, she carried a diagnosis of inflammatory breast cancer (diagnosed in 2007). With courage, grace and honesty, she blogged about her journey through chemo, mastectomy, remission, recurrence, hospice, and too much pain. Yet what defined her was not this; it was a true joy of living, of living each breath, of tremendous advocacy, that made her luminous beyond the normal range of our ordinary mortal existence. She was the type of person that if you met her, you loved her. Simple as that.

In the homily, I learned something new about Susan: she had undergone an accelerated Rite of Christian Initiation of Adults (the process by which adults convert to Catholicism) to develop a deeper relationship with God and to draw strength from this relationship through her illness. Seeing her and her family at church each week, I had assumed her faith and religion were constants in her life equation - not something so new and dynamic. I thought about my own RCIA experience 9 years ago and how much that has meant to who I am today.

Since her death, so many who loved Susan have written about her and about how they will honor her. Encouraging their children to love science, to practice present-parenting, to support breast cancer research, to schedule their mammograms. For me, she will inspire me to have more faith, less doubt. Yes: More faith. Less doubt.

Because, I doubt. I worry. In the almost-year that my husband has been stationed in Afghanistan, the anxiety has ebbed and flowed, with occasional spurts of outright fear. I play mind games with myself, practice superstition, believing that the course of events could hinge on a mental misstep. In everyday life I worry too. Small things that shouldn't matter. Small things that wouldn't matter if I had Susan's perspective and her faith. Why not practice more faith, more optimism, more belief in the goodness of others? Because life is too short to worry so much for things beyond our control.

A friend on Facebook shared this recently: Worrying is like praying for what you don't want. I never thought of it that way, but how true. Why devote such time and energy to such negativity when there is living, loving to be had? Why not allow one's faith to carry some of the burdens?

Susan was good at many things but perhaps what she was the very best at was loving others. This was evident at her funeral - her love reflected in all those who came was evident. Radiant. Uplifting. Her best friend, a professional musician, sang the Gospel hymn "His Eye is on the Sparrow" in a voice so pure and clear - quite possibly the most beautiful thing any of us have ever heard. We were rapt. Silent. Reverent.

If we all could believe and love a fraction of what Susan could, imagine how many more breaths would be filled with joy instead of fret. Hope instead of worry. Striving towards this is how I will remember Susan. She is the cheerleader I'll hear on the inside. The hug from within.

In a wonderful interview last year, Susan was asked, "you're a role model for finding beauty and joy in life no matter what happens - what are your top 'little things that count?'"

Her answer:  Children’s laughter. Soap bubbles on a summer afternoon.  Reading books together in an easy chair.  Family meals.  Cuddling.  Taking time for a night out with friends — even when there is other work to be done. Stargazing or watching the clouds pass by. Asking a child a question, and listening — really listening — to her answer.

We said goodbye to Susan this week but her inspiration lives on inside us all.

Friday, January 27, 2012

Overheard in a MiM car

[On the way to 4-year-old son's doctor appointment]

MiM: We're going to the doctor's! Do you want to be a doctor when you grow up?

Son: I can't.

MiM: Why do you say that?

Son: (Pause)...are there daddy doctors?

MiM: Yup. There are daddy doctors.

Son: OK, (with glee) I want to be a doctor!

Thursday, December 15, 2011

A Hospitalist in Academics

I fell into hospital medicine rather unexpectedly. I knew I wanted to stay in general internal medicine, but I thought I would be a primary care internist. Then, in residency, I discovered how much I loved the inpatient setting - not for the actual medicine part - but for the educational part: I loved teaching and the ability to do so with scale with the large learner-heavy teams on the wards.

A lot of people equate hospitalists with shift work, and in many cases, this is true. Working within well-defined and pre-scheduled shifts may be very alluring to mothers in medicine: predictable hours, a defined schedule, potentially no call, and the flexibility to easily work part-time.

However, for my particular job as a hospitalist in an academic setting, I don't do shift work. Most of my clinical time is supervising resident-run teams (the other clinical time is spent doing consults or supervising a PA-led "non-teaching" service without residents), which means longer or shorter days depending on team census, the acuity of our patients, whether the resident or interns are in clinic for the afternoon, call-days, and how independent my resident is (new R2 very different supervision time than a seasoned R3). I'm available by phone to my teams when they are on call at night. I work many weekends and holidays. And although I can take compensatory days off in lieu of working the holiday, which is great and something I put into action as chief of the hospitalist section, my kids will be home without me.

Parts of my clinical job are absolutely draining, mentally and emotionally. There's the family meetings to discuss goals of care in dying patients who may or may not have decision-making capacity. There's the bearing witness to tremendous suffering -like those with difficulty coping that they have a chronic disease that brings them in and out of the hospital so frequently. But, these parts are also what give me pause - I have a job where I can make a difference. I can make someone's suffering heard, metabolized, and given meaning. I can lead a difficult family discussion and make sure everyone's needs are identified. Hard but good.

I'm in my 9th year as a full-time hospitalist and in that time, have had three children. I've taken on more administrative duties and my weeks on the wards have accordingly decreased. I have the flexibility to do research, to do committee work, to teach. I'm meeting my personal goals of academic success. I feel like I am compensated fairly for my work and the requirement to work some weekends and holidays. This scaling back of clinical duties has been critical to achieving the balance I need as my family has grown. Granted, I worked my butt off in the beginning doing a much heavier clinical schedule, starting a family, and establishing my ability to take on these non-clinical duties and establishing a research agenda to be able to scale back these last few years.  On admin time, I have major flexibility. Flexibility to linger after school drop-off and chat with the other moms. Flexibility to help out with my daughter's art class. I know I have a really good thing going. And it works. Like others, key to this working for me is: 1) an amazing husband who shares the responsibilities of our home and family equally (minus this last year when he's been deployed to a war zone but that's the topic of another post...); 2) supportive and nearby family; 3) great childcare (which currently is synonymous with number 2); 4) having a flexible enough work environment and an awesome boss; 5) I try hard not to drink the Working Mother in Medicine Guilt Kool-Aid, no matter how tempting it looks some days. (Note operative word is "try.")

Hard but good. I think that about sums it up.

Friday, September 2, 2011

The MiM Risk Score (MRS)

In honor of the Labor Day Holiday...

This evidenced-based risk score was developed to help predict overextending of Mothers in Medicine. The goal is to prevent burnout, stress, and associated unpleasant psychological states by monitoring weekly risk, and following guidelines for treatment accordingly.

To calculate risk:

MRS =          age/2 * number of dependents + k [C + Lu + Na]
                             Number of spouses/life partners * + 1


Age = Age of MiM in years

Number of dependents = number of children, care-requiring parents, exceptionally ineffective spouses/life partners, very large and needy household pets. For pregnancy,  multiply total by factor of 1.5.

k= work constant. For full-time work, k=1. For part-time work, k= 1.5 * % of full-time worked (e.g. ½ time = 0.75 since hours worked is always more and uncompensated)

C = number of times you have to call your cell phone to find out where you put it in the past week.

Lu = number of times you are too busy to eat lunch, forget to eat lunch, or accidentally bring a Tupperware with a half ear of corn and half of a large white onion by mistake instead of the lunch you packed the night before. Hypothetically speaking.

Na= number of times you have called your children the wrong name in the past week.

*for polygamists, add only 0.5 for every successive spouse after primary spouse; for work spouses, add 0.25 each; only spouses/life partners currently living with you for the majority of the week count in full.

**** Risk score interpretation ****

MRS > 50 = High risk for overextending. Schedule child-free vacation, delegate projects, get a babysitter for a night out, add another spouse/life partner (or increase efficiency of current one), for the love of God say no to new commitments. Wine.

MRS 41-50 = Moderate-high risk of overextending. Schedule spa date. Say no to new commitments. Delegate projects. Possibly add another spouse/life partner (or increase efficiency of current one). Adjunct retail therapy.

MRS 30-40 = Moderate risk of overextending. Schedule coffee with girlfriend(s). Say no to new commitments. Delegate projects.

MRS < 30 = Low risk of overextending. Good job! Offer help to your MiM friends in higher risk categories.

n.b. Risk score prognostication has not been scientifically validated.

Wednesday, June 15, 2011

Don't Give Up on Women in Medicine

The Mary Elizabeth Garrett Room lies off a busy corridor on the main floor of Johns Hopkins Hospital. As a medical student and later an internal medicine resident at Johns Hopkins, I often treated the small women’s lounge and adjoining locker room as a sanctuary amid my hectic days and nights of studying and call. Its namesake, a philanthropist who was one of the wealthiest women in the US in the late 1800s, used her financial power to provide opportunities for women to gain independence and autonomy.  She and her friends offered to raise a badly needed $100,000 for the endowment of the Johns Hopkins School of Medicine if the trustees agreed to admit women on the same basis as men.  The rest, for future women in medicine, was history.

In her New York Times opinion-editorial  “Don’t Quit This Day Job” (June 12, 2011), anesthesiologist Dr. Karen Sibert argues that women physicians, who increasingly work part-time or leave clinical medicine altogether to find better balance between work and family life, have a moral obligation to practice medicine full-time. She rightly points out that there are limited medical school and residency slots in the face of a growing physician shortage, particularly in the primary care fields that attract women in high numbers. However, Dr. Sibert’s envisioned ideal would be a great loss to patients and the profession, and a major step backwards for women in medicine.

Historically, the practice of medicine had required a selfless devotion to the profession at the cost of personal and family life.  Turn of the 19th century legendary physician Sir William Osler is credited for saying, “Medicine is a jealous mistress; she will be satisfied with nothing less.” These roots are evident in the harsh training environment that prevailed for so many years, requiring super-human work hours, rare days off, and expectations to work through personal illness. Slowly, medicine professional culture has made progress, realizing that the care of its members—in all senses of that word—helps physicians (men and women) lead more balanced, healthier, happier lives and helps patients by improving the quality and safety of their healthcare experience through physician work-hours restrictions.

For women physicians, who continue to perform the lion’s share of household duties and child-rearing despite a more progressive society towards the division of household labor, this has meant the increasing availability of part-time positions, job-sharing, and other creative solutions to allow them to continue practicing medicine while fulfilling commitments at home. Achieving work-life balance means greater satisfaction for one’s career and keeps women (and men) physicians in medicine. Indeed, it is this flexibility that is possible in certain specialties such as primary care, dermatology and radiology that makes medicine an attractive career for many women, despite the years of difficult training and medical school debt.

We are, after all, talking about a profession that is built around caregiving, with the parallels between caring for patients and families undeniable.  Women physicians spend more time with their patients, up to 10% more, and have been shown to have a distinct style of doctoring from their male counterparts: more encouraging, supportive and patient-centered. The contributions of part-time women physicians are no less in quality to the lives of their patients; shouldn’t such devotion to caregiving at work and home be traits encouraged in physicians? 

Invoking the predicted physician work shortage as a reason why women physicians should not work part-time or leave clinical medicine places undue guilt and blame on them.  The main factors driving up physician demand is the growth and aging of the US population and health care reform.  While women physicians do work fewer patient care hours compared to men, what kind of profession would we have if women who might decide to work part-time later were denied admission?  More reasonable (and humane) answers to the physician shortage lies in lifting the residency training caps to train needed physicians and creating new models to increase efficient use of the existing workforce.

Besides, women (and also men), who choose to spend a portion of their medical careers working part-time or who take an extended leave, may return to full-time work at a later time, for example, after their children reach a certain age. Thus, there is a need for effective physician-reentry programs that help prepare any previously trained physician to return to the workforce, providing education and re-training as well as portals to reenter medicine.

Let’s not forget about the men. Besides early to mid-career women, men approaching retirement age are the other fastest growing segment choosing to join the part-time physician workforce. Survey data show that today’s medical students and residents, both men and women, say achieving a balance between their work and professional lives will be the most important factor when establishing a fulfilling career in medicine. Medicine mistresses are going out of style all-around, much to the dismay of the medical henchmen: Burnout, Stress and Dissatisfaction.

To be sure, medicine is a public good. Federal dollars support physician training, and certainly, it is imperative that medical school admissions committees select applicants, male and female, who show a strong commitment to medicine. Yet after training, men as well as women may decide not to practice clinical medicine. Is it more problematic when the reason is because a woman wants to raise a family versus a man who takes a job with a consulting firm? I hope not. These are difficult personal decisions, emphasis on personal.  Like everyone else, doctors need to make decisions for the health of themselves and their families. Life happens.

I am a mother, and I am physician.  These two roles are complementary in more ways than they are not. The increase in flexibility for women physicians in recent times has been a boon to those of us who have found a calling in medicine but do not want to sacrifice having a full family life. Isn’t that what Mary Elizabeth Garrett had in mind as well? Independence and autonomy for women to practice what they love, to be empowered by having choices.

Katherine Chretien is founder/editor of

Wednesday, May 4, 2011

Twitter to Tenure: My (parenthetical) story

I'll soon be heading to the 2011 Society of General Internal Medicine's annual meeting. As prelude to a workshop called "Twitter to Tenure," I, and several fellow academicians are blogging about how social media has helped our academic careers. See bottom of post for the other posts in this series. And if you'll be at SGIM, please come and say hi!

If I had known that starting a personal blog in 2006 would eventually result in such great things for my career, I would have started one a long time before that. The truth is, I was simply trying to capture the moments of new motherhood that I didn't want to forget. (Also, before 2006, I was like, what's a blog?)  In the process, I unknowingly set wheels in motion that would eventually help shape my future personal and career pursuits. (Bonus!) This is what you call a win-win. Win-wins in life are the best.

Writing leading to...
In my early days of blogging, I posted feverishly, to my 3 readers, one of which was my husband. We're talking practically everyday (I sigh when I think about how much more time I had when there was only 1 child to contend with). In the process (of talking to those 3 people), I developed my writing voice. It became like nothing to write a post- I could whip one out in 5-10 minutes, honing my story-telling, organization and my writing got better. (Please do not use this previous sentence as an example.) Malcolm Gladwell talks about this 10,000 hours phenomenon to achieving excellence in anything--I haven't come close to that but blogging so frequently was a start.

Writing opportunities...
An amazing thing happened in the midst of blogging feverishly (now over 3 readers): people found my blog and offered to pay me to write about parenting --humor writing. Paid! To write! This was a huge boon since it felt like I was an actual writer who could (occasionally) make people laugh. Meanwhile, the blogging (on multiple blogs now) continued, more hours under the belt. I networked with other bloggers, went to blogging conferences (after at first scoffing at them--who would go to a blogging conference??? Lame. I've realized, since, how much I love eating my words, or at least, embracing being lame.). I am not sure when my affinity for using parentheses developed.

And medical education applications...
I now appreciated what blogs could offer (discussion, community, feedback, support, to name a few) and while studying adult learning theory and the theoretical underpinnings for reflection in medicine, started a reflective writing blog for internal medicine clerkship students. Students' writings blew me away as they wrote frankly (amazingly frankly) about professionalism, doctor-patient relationships, empathy, and the struggles and anxieties of being a medical student. This led to workshop presentations at conferences, a paper in an academic journal, and networking with some pretty awesome collaborators.

And research....
Having had a blog where I occasionally mentioned issues that I saw in the hospital, as well as developing a (vaguely, on good days) humorous writing voice, I could appreciate the line that physician-bloggers had to manage between privacy, humor, disclosure, and professionalism. I became interested in the intersection of professionalism and physicians on social media and had an idea for a study on medical students and unprofessional online content. I also got involved with other forms of social media - Facebook and Twitter - and more ideas for studies came. This research has led to plenary talks, media interviews, grand rounds invitations, national conference workshops, and has defined a career path. Not to mention it's just fun to do these studies. Note: I would have never imagined I would be doing research when I was a resident! Thoughts of doing research in the past had always been accompanied by images of pain and suffering, like having a fork stuck in an eye.

And staying up-to-date with news from my field...
I've become a Twitter convert, thanks to Twentors (sorry) like Vinny Arora, an amazing academic rock star and Star Tweeter (ST). It has become my go-to source for breaking news and keeping up with my areas of academic interest --medical education and social media in medicine. I do not follow anyone like Paris Hilton ("I'm sooo tired! Need a nap!"), and instead follow those who have similar interests (as me, not Paris--pretty sure our interests don't overlap) or provide interesting perspectives and links. See Vinny's post for more resources about how to use Twitter professionally.

And Mothers in Medicine...
And of course, blogging led to the birth of Mothers in Medicine. Enough said.

So, social media has been good to me. It might also be good to you too.

Also see the following STs:

Alex Smith's (@AlexSmithMD) intro post on Geri Pal.
Vinny Arora's (@FutureDocs) post on FutureDocs.
Bob Centor's (@medrants) post on DB's Medical Rants.
Eric Widera's (@ewidera) post on Geri Pal.

Thursday, April 28, 2011

Speaking out about kids, football, and traumatic brain injury

I attended a Grand Rounds on Chronic Traumatic Encephalopathy (CTE) and the NFL earlier this year given by neuropathologist Dr. Daniel Perl. It was eye-opening for me. Despite all the recent media attention given to cases of NFL players being diagnosed with the disorder post-mortem (usually following untimely deaths due to suicide or bizarre "accidents"), it hadn't really penetrated my consciousness. But to see the actual images of abnormal tau protein staining in these relatively young brains - heaps and tangles similar to Alzheimer's but in slightly different locations - well, it was chilling. Even more chilling was hearing about these findings in younger players, those without years and years of professional-level play. Including those without many (or any reported) concussions. I started thinking about all of the children in the US who play tackle football and wondering: When are these changes happening? Why aren't we talking about this re: children? How many mothers might not realize that their children could be sustaining irreversible injuries that only manifest many years later? This. is. huge.

I debated whether or not to write about the issue. On the one hand, I felt passionately that discussing these issues was a matter of public health. Yet, I also weighed this against the likely backlash from football supporters and the kinds of personal attacks that commonly happen on the comment pages of online media forums.

In the end, I decided that this was too-important of an issue not to write about, stick and stones notwithstanding. My op-ed is in today's USA Today. Would love to hear your thoughts (including dissenting!), mothers in medicine, about this issue. Do you (would you) allow your children to play football? Do you think developing CTE is a reason for concern in kids? What do you think should be done to protect kids who play? Pediatricians, do you discuss this with your patients/parents?

Tuesday, February 15, 2011

This one's for the girls

At the risk of exposing my musical tastes (and innate sappiness), I have a confession to make. Whenever I hear Martina McBride's This One's For the Girls, I tear up. I'm so not kidding. I'm not even a country girl--I prefer The Killers to Carrie Underwood --and I couldn't tell you another song that Martina McBride sings. But, this song has always made me want to link arms with women everywhere, celebrating how much we share in common: the broken hearts, the high dreams: reality ratio period, our struggles to find ourselves. You're beautiful the way you are. See. There I go again. (NB: for all of you who have never heard this song, I suggest playing the YouTube video linked above but just listening; the video kind of weirds me out. Who directed that thing?)

It's with this background that I write this post, a post I've had in mind for awhile now and directed to all of you in your 20's.

What I wish I knew in my 20's: it gets so. much. better.

When I was in my 20's, I remember thinking that this must be my peak age. Bone mass and fertility must all go downhill from here. I had no reason to believe it shouldn't. I steadied myself for a future of decline in all respects.

Now, comfortably past the mid-way mark of my 30s, I would never trade being in my 20s again for now. Now is awesome. With time, the insecurities, the not knowing myself, have gradually slipped away. I feel more powerful, confident, and, yes, comfortable in my skin than ever before. With time, I know me, accept me, in ways that the younger, more stronger-boned and fertile me could never have imagined. Plus, now there is a growing family - and the joy and richness that brings, a more mature (and ever stronger) relationship with my husband, and a satisfying career on a path that I'm setting, not anyone else. The 30s rock.

And, I have a suspicion, and a hope, that it just keeps getting better. Perhaps "all you girls about forty-two" could chime in...
There's no need to fear growing older, MiMs. Look forward to it. The best is yet to come.

Thursday, January 20, 2011

Tiger Mother I am not

I'm a Chinese-American mom, but I'm no Tiger Mother.

I'm almost loathe to start this post as I don't think Amy Chua, and her book, could possibly have more press. I also fully disclose that I did not read this book, having only read (the scary) excerpts and multiple articles and blogs about the book. I did hear her on NPR with Diane Rehm when she defended the "tongue-in-cheek" nature of the book and how it represents an evolution of her own parenting. (Although, it seems that many people who have read her book in its entirety seem to have missed that subtlety.) My friend Joanne wonders whether her form of parenting represents child abuse.

I grew up the daughter of Chinese immigrants who, if anything, were on the permissive side. Sure, they valued good grades and hard work but honestly never pushed me. This might be, in part, due to the fact that I was doing well anyway, but I remember their mantras whenever I called home from college were two: 1) make sure you get enough rest; 2) don't study too hard. In high school, I did cause quite a bit of their concern when I declared I wanted to get a part-time job during the school year. Not out of necessity, I didn't need the money, but, what can I say? I wanted the experiences my friends had. I promised them that I would stop if my grades suffered. (And looking back, the experience of working minimum wage in discount retail was enlightening.) My parents' parenting style was the envy of my circle of friends: I had no curfew (although my dad would nonchalantly stay up, probably developing an ulcer, while waiting for me to return home on Saturday nights). I watched a lot of TV. They allowed me to give up piano lessons when I likened my times with my mid-life-crisising piano teacher to extreme torture.

I did have ABC (American Born Chinese) classmates that had proverbial Tiger Mothers. These women terrified me. Their children were polite, respectful, disciplined and high-achieving, but something was off. There was a hardness to these boys (they were often boys), and, often, a social awkwardness. I felt for them. And very glad I had a different upbringing.

On the flip side, the criticism that American parenting culture is too permissive is interesting to explore. Are we not pushing our children enough (not to TM extremes but isn't some pushing necessary)? I semi-struggled with this as I've watched my 5 year-old daughter beg for piano lessons...then totally lose interest a few months later. Same with dance class. When it got to be a monumental struggle to get her to even pay attention to her teachers or go to class, we've allowed her to stop. The feeling was that maybe she's not ready and when she finds something that she is truly passionate about, it wouldn't be such a Herculean effort to get her to practice. More physical activities, like swimming and gymnastics, have held her attention week after week. We are "following the child" as her Montessori teachers say. This makes a great deal of sense to me. I don't want her to do something for me, or for the sake of doing something. I want her to do something and work hard at it because she loves it and derives happiness in the process (That's possible, right?). But I sometimes wonder if I'm doing her justice by letting things go too easily.

One possible ill consequence of the TM method is raising children where conformity over individuality and creativity is selected. The Chinese have produced a nation of math and science heavyweights, but where are the visionaries? The Apples? The break-out ideas?

Chua, on NPR, wanted it to be known that her book was not a how-to-guide to parenting but a memoir. She clearly has struck a chord with mothers (and parents) everywhere. As much as she's been demonized in the media, I think this comes from a place of insecurity, that we all carry, about how we are doing as parents. Could we not be giving our children the best advantages in life?  Are we doing it wrong? At the heart of the "Mommy Wars, " afterall, is insecurity and wanting to believe that our parenting, one of our most precious tasks --to "successfully" raise a child -- is right.

I hope that her daughters grow up to be successful, as defined by their own beliefs and that this backlash towards her mother's memoir doesn't do any permanent damage. We are all mothers, doing what we think is right, in the best way we know how. After all.

Wednesday, January 12, 2011

40 hours

40 hours. Some people put in 40 hours per week at work. It is 23.8% of an entire week. It is also the approximate amount of time I get to spend, in person, with my husband every week. Which makes 40 hours an allotment of time that has taken on new, precious meaning during the past 6 months while my husband has been stationed away from the family, a 6 hour drive (on a good day) away .

That 40 hours includes the time spent sleeping over 2 nights. It includes the time we attend to our own needs: work outs, showers, etc. It includes the time caring for the kids together, at gymnastics and swimming lessons. It sometimes includes the time I spend at work when on-service and covering a weekend. It is time that we are intensely focused on being together, of being a team reunited. It is time I can't wait for at the end of each week, and time that passes all too quickly.

I know this now: we will never take living in the same house, of falling into the same bed each evening, for granted again.

Making each week's 40 hours, from Friday, late at night to Sunday, early afternoon, that much more savored is the fact that soon,  in a couple of months, those 40 hours per week will become 0. 0 x 50 weeks to be exact, the amount of time that he will spend in Afghanistan in active duty. He'll have a total of 2 weeks of "R and R" sometime in the middle.

Working full-time and parenting 2 small kids with 1 on the way (6 weeks and 1 day to go before due date, but who's counting) has only been possible by lots of help at home. Ever since we had nannygate x 2 late last fall, my parents have basically moved in and are a tremendous help. They plan to stay well after I have the baby when another family member has committed to helping for several months. The new nanny search can wait until then.

Despite all of this madness, I'm remembering to count my blessings because they are many. To have retired parents willing to give up their previously enjoyed retired life to come live with us. To have a job which leaves me satisfied, happy, and not (usually) overworked. (Any overworking is my own fault and side projects I've taken on, not expected by my job). I have a wonderfully supportive boss who understands my family situation. I have a rock-solid marriage; we know that this separation and challenging 12 months ahead will only bring us closer. I have the world's best neighbors. We have fabulous friends who have helped so much already this year, both in their actions and their mental and emotional support. We belong to a wonderful church. So, now, 2 months before he is deployed, I am at peace and stand ready to face what comes my way.

One of my Christmas presents this year was a Philosophy set of products from their Amazing Grace fragrance line. If you're not familiar, Philosophy products come with smart names and little blurbs that inspire. The blurb on the Amazing Grace body butter I found especially resonant:

"how you climb up the mountain is just as important as how you climb down the mountain. and, so it is with life, which for many of us becomes one big gigantic test followed by one big gigantic lesson. in the end, it all comes down to one word: grace. it's how you accept winning and losing, good luck and bad luck, the darkness and the light."

My plan is to wear this and live this. Every day. It smells, well, amazing, and it might just help me through the months to come.

Saturday, December 18, 2010

The work*life product and other insights

We've been talking about work-life balance this week in the context of motherhood, but clearly this is a concern for anyone in medicine. Partly, I think this comes from the personalities that are generally attracted to/selected by the field, leaning towards the driven and perfectionistic (and at times, a-retentive), as well as the demands of caring for patients: hard to turn off, hand off, or leave at the door. For me, though, motherhood really made this concept all the more relevant, as suddenly the "Life" part of the equation got significantly more complex. Having to stay late at work takes on a whole new meaning when that means you might miss a meal or a bedtime of someone who is "your heart walking around outside of your body."

These past 5 1/2 years of motherhood and living work-life balance have given me some early insights:

Work-life balance is highly personal. Set your own standards.

We were on vacation over the summer at the beach for one week. During the week, I had a monthly work-related conference call for a national committee I serve on. I decided beforehand that I would see how the week was going (the call was near the end of our week away), and that I'd call in for it if I felt like it. Well, I felt like it. After spending 24/7, all-family, all-the-time, (including an 8-9 hour car ride involving listening to 2 hours+ of straight crying), I was ready for a brief break away, if only by phone. Yet, calling in and admitting that I was on family vacation at the beach and might not stay on for the whole call made me suddenly self-conscious, much like I feel self-conscious about sending colleagues manuscript drafts on Friday nights (I have). I wondered what they were thinking and whether my "balance" was questionable.

But, I have come I'm coming to accept the fact that I draw so much satisfaction, meaning, and identity from my work. I would be miserable not working at all and taking care of the kids full time. I would likely be miserable working only part time. Doing meaningful, satisfying work makes me happier when I am home, more patient, a better mother than I would be otherwise. And, I'm telling myself that it doesn't matter what others think, as long as I am happy with the way things are going, that my family is happy with the way things are going. Really, that's what matters, not someone else's standards. (And who cares what others think?)
There's no ideal "mix" or balance that fits everyone. Finding your own "groove," is key.

"Work-life balance" is a less helpful concept for me than "work-life product"

When I think about balance, I think about a see-saw, with work sitting on one side of the fulcrum and life on the other. That seems to denote that to be in balance means to have similar weighting to each side, in similar quantities. Yet, in real life, I feel that these weights are always in flux and being in a state of mental/emotional harmony depends on the work*life product to be under a certain threshold (much like the calcium-phos product). For instance, it would be okay if family needs became temporarily higher when work needs were low, or if a flurry of work demands occurred during times of quiet on the home front. But, when both of those demands become high for whatever reason, that's when things get untenable. Hopefully those times are only temporary, resulting in only a minor amount of pesky metastatic calcification (e.g. my nanny nightmare + temporary work insanity = sad me), but when they are sustained, then changes have to be made.

Your workplace "terroir" can greatly affect/encourage/stifle your sense of balance

In wine-making references, the term terroir refers to the sum effects of a local environment (the specific geography, climate, soil, farming techniques, etc) that results in the final product. At work, the organizational culture surrounding work-life issues-- managers, your boss, colleagues, inherent flexiblity of your job-- all contribute to your sense of balance. When I first started working at my job, I didn't feel it was very supportive to me as a new mother. When I announced my pregnancy, the first response was "how long will you be gone? 6 weeks?" (In my ideal world. it would have been, "Congratulations! *hug* How can I help you?") I was the only mother of my group and worked with many men who gave me a hard time for missing conferences due to pumping--I felt like a criminal trying to get out at a reasonable hour to see my child before her early bedtime. Yet, now, things have changed. Those men have left (hooray!), I've negotiated for more protected time (hooray!), and now, I have a supervisory role that allows me to create a environment that emphasizes the importance of work-life. Small gains like instituting policy and precedent for my section to take "in-lieu" days off for having to work a holiday hopefully will add up to an overall supportive culture. Finding a work environment that meshes with your own ideal of work-life balance can't be underestimated, and if not, work to change it if you can, either from within or finding a new job (like dr whoo courageously did).

Re-evaluate, re-evaluate, re-evaluate

As with any process, it helps to periodically re-evaluate to make sure things are going smoothly from everyone's perspectives. I remember one time when my husband mentioned (jokingly) something about how we both just tended to get absorbed in doing work side-by side on our laptops after the kids went to bed each night. It was totally true, and a reality check. It's so easy (for me) to get sucked into (bad) habits and not stop to reflect, or step away and see the big picture. I need to be reminded to take that time to re-evaluate and to check in with everyone.

Best of luck to all MiMs out there, finding your own work-life groove and defending it. And periodically checking in with all stakeholders (yourself, your partner, your children) to make sure nothing needs tweaking. And definitely keeping that work*life product to non-toxic levels.

Monday, November 15, 2010

Nightmare on Nanny Street

Things had been going well, as well as could possibly be expected, ever since my husband moved down to N.C. a few months ago. My dramatic post about becoming a single parent seemed almost silly in retrospect, since here I was, having a ton of help and support all the time, between my parents, my in-laws, my husband on almost every weekend (yes, driving the 6-8 hours each way), and our live-in nanny. Yes, I pulled more double bedtime duty than I had been accustomed to M-F, but it was hardly the hardship I imagined.

Tempeh, who has been through multiple deployments, and who is quite possibly The most supportive friend in the history of supportive friends and who has made offers weekly to help in some tangible way, joked a couple of months ago that I was overdue for a major appliance failing, a fate that befalls almost every newly-alone spouse of a deployed servicemember.

My appliances, thankfully, are all in good working order (I am furiously knocking on wood right now), but my once-rock-solid nanny situation disintegrated before my eyes.

I will save you all the gory details, but even before the sordid events that unfolded over the course of a couple of months, we had certain reservations about her as a childcare provider. Namely, that while she was perfect for an infant: loving, warm, patient, calm, she was highly ineffective with a toddler and a kindergartener:  entirely passive, indulgent, and without a limit-setting bone in her body. Yet, we were willing to ride it out until the new baby came in a few months and her primary focus would be, again, a newborn. The older two kids would be at school all day.

But, then, the sordid events happened, involving a quite-possibly mentally unstable boyfriend to nanny who would not stay away from our house or our children despite our many requests, and to top it all off, reports from the school that she and said boyfriend picked up our  two-year-old son from half-day pre-school and put him in boyfriend's car, without a car seat and sitting on her lap in the front passenger seat.

Stress? Yes, hello, it's me again. This all went down on my birthday, of all days, and right before a month for me that included 3 work conferences, including 5 presentations and being attending on wards.

We fired her immediately. My parents moved in temporarily. It was all very sad since she had been with us for over 2 years and was very much a part of our family. She had taken care of my son since he was 9 months old and he was/is very attached to her. When she moved out, she cried and hugged me for at least 10 minutes straight, telling me how very sorry she was and how I was like a daughter to her.

This has all highlighted for me how tenuous having a nanny can be. Great one minute. Disastrous the next. I can't tell you how many times my husband and I have told each other how lucky we were to have had our nanny over the past 2 years. Up until recently, it was truly great and made our lives many times over easier. And now, we're/I'm starting all over again. No one is going to be perfect, I know. But, it's scary how far from perfect they can be.

Wednesday, October 6, 2010

Blogging ad infinitum

In 2006, my daughter was 1. That first year was so full of everything new: new feelings (both good and awful -hello, postpartum loveliness), milestones, joy, challenge, humor...I made some lame attempts to record what was going on in a journal, but I always felt like the richness of that year was lost forever. Sure, I had plenty of pictures (digital camera + first baby = photojournalism insanity).  But, it didn't seem quite nearly enough.

I  soon thereafter discovered blogs, well, mommy blogs (as unappealing as that phrase is to me), and realized what I had been missing. Here it was, the richness. I particularly recall coming across Dooce's blog and being captivated/jealous/inspired by her monthly letters to her daughter which captured the essence of that month in her daughter's development.

I want to do that,
I thought.

So, I started a personal blog, mainly intended to be devoted to my daughter. I wanted our family and friends to know about what she was doing, learning. And, I wanted to write (again). I (also) started a monthly tribute to my daughter on my blog, but instead of a letter, I decided I would post her developments in the form of a software update, complete with new features and known operating failures: Version 14.0 was the first release.

At first, the only people who knew about my blog were my husband (who would always be the first to read my posts no matter what) and a few friends and family. I soon discovered a whole community of supportive bloggers whose writing I admired - I'd post comments on their blogs and they would on mine. It was like having a cheerleading section with you - along for the ups and downs on your life ride.

Pretty soon, I was writing on a regional moms blog, freelance writing a blog for Disney (long story, but short version: they found my personal blog and asked me to write for them), and blogging was suddenly a very big part of my life. My husband has always been my number one reader-fan and despite my writing for multiple outlets, always made sure to read my posts and murmur supportive things about them. He sometimes would half-joke that everything - every funny conversation we had -might make it onto the blog. I tried to be sensitive about that since he's more of a private person than me. He once actually guest-wrote about what it was like being the husband of a blogger (me) on one of the blogs I was writing for. I loved reading his perspective.

My family knows about my blogging (even though it still weirds me out when I can see that my retired Dad has refreshed my blog page 20 times or more in one day) and my co-workers. In fact, a whole lot of people who know me know, apparently, sometimes catching me off guard. Mothers of friends have mentioned certain posts to me, and the other day, a former intern of mine stopped by my office to talk about a mutual patient when he mentioned HE was reading Momicillin and wanted to congratulate me on my pregnancy. (In my mind, I manually closed my jaw with my hand. In real life, I smiled back and said, "Thank you!!!")

Over time, I've tended to mask the identity of my family more and more while unmasking my own- I guess I'm making it more about me than about them which I think has more to do with giving them more privacy and exposing myself than about narcissism. (Hopefully.) Personally, I have come to believe in taking ownership for my words and my thoughts and standing behind them, for better or worse.

Blogging invaded my academic life and I started using private blogs for reflective writing with medical students and in 2008, this blog was born. I've had to give up some of the other blogging gigs along the way, but this blog, with its community of readers, with its writers, with its stories, is still one of my proudest bullets on my CV. I owe MiM for producing some of my most valued IRL friendships. These women I write with here are simply amazing.

And the versions? They continued  on until Version 42.0 when I thought my daughter was getting old enough that it was becoming less my stories to tell in so much detail. Like Fizzy, I went back and published all of those old posts in a book, to give to her eventually. Now, I'm up to Version 33.0 XY for my son (although these have become far more sporadic like hers did at the end and plan to publish his own book of posts one day. In a few months, I guess I'll be starting all over at Version 1.0 XY(2)...and so it goes.