Showing posts with label Mommabee. Show all posts
Showing posts with label Mommabee. Show all posts

Thursday, June 13, 2019

Sneezing, coughing, itchy eyes! Oh my!


It’s that time of year. In my practice, I am seeing more children and adults with sneezing, puffy eyes, itchy eyes, forehead headaches, you name it. Look outside and the reason is clear, our region is plagued by significant amounts of tree and plant pollen and flowers and trees are blooming. The pollen blankets our sidewalks, cars, and homes with fine, green powder that causes a range of allergic symptoms.

My son and I have horrible seasonal allergies. I get runny eyes and sinus headaches (the pressure above my eyes, across my forehead, and next to my nose) and he gets puffy and itchy eyes, sneezing, coughing, and asthma flares.

Here are the basics that we use to keep things under control:
-       Avoid indoor allergens by vacuuming and dusting regularly.
-       Avoid strong smells indoors such as bleach and air freshener plug-ins and instead try fragrance-free cleaners and a few drops of essential oils mixed with water. 
-       Let kids play outside as much as possible but pay attention to the Air Quality Index on the news. After playing outside, have kids wash their hands and face to rinse off the pollen.
-       Rinse your sinuses with saline (special salt) water to get rid of all of the pollen. You can buy a sinus rinse bottle or neti-pot for less than $15. When you are having a lot of symptoms use it two times a day, once in the morning and once at night. When things are going well, just use it once a day at night before bed. Sometimes my patients do not even need other medicines when they rinse their sinuses out regularly.
-       If needed, talk to your doctor about fluticasone nose spray or antihistamines that don’t cause sleepiness such as cetirizine (Zyrtex) or loratadine (Claritin).
-       Avoid using antihistamines that cause sleepiness such as diphenhydramine (Benadryl) too often unless prescribed by a doctor.

With these few tips, I hope that you can avoid sneezing, coughing, and itchy eyes.

For more information, check out a short article: https://kidshealth.org/en/parents/seasonal-allergies.html


Friday, May 10, 2019

My ideal medical practice - I opened up shop!


House call doctor tools of the trade. I have since gotten another rolling bag.

Over the last few years I have slowly been inching toward establishing my own practice. And this January, I did it, I incorporated my practice, Healthy Home Pediatrics! It is a house call based concierge, or direct primary care, practice serving Washington, DC and the surrounding Maryland and Virginia areas.




It feels so good to work hard for my own vision. For the last 5 years I have worked extremely hard for visions that were established by hospital administrators or the organizations that I worked for. Too often, these visions fell short of what I knew my colleagues and I were truly capable of and far short of what patients really wanted and needed.


During times like this, when I am venturing into the unknown, I often go back to one of my all time favorite books, The Alchemist, by Paulo Coelho. I have read this book countless times. In it, Coelho shares the story of a young shepherd boy who leaves home and goes in search of his dreams. Along the way he is tested and experiences both profound joy and deep disappointments. One of my favorite sections of the book shares a conversation with the boy, his heart, and the alchemist:


“People are afraid to pursue their most important dreams, because they feel that they don’t deserve them, or that they’ll be unable to achieve them. We, their hearts, become fearful just thinking of loved ones who go away forever, or of moments that could have been good but weren’t, or of treasures that might have been found but were forever hidden in the sands. Because, when these things happen, we suffer terribly.”


“My heart is afraid that it will have to suffer,” the boy told the alchemist one night as they looked up at the moonless sky.


“Tell your heart that the fear of suffering is worse than the suffering itself. And that no heart has ever suffered when it goes in search of its dreams, because every second of the search is a second’s encounter with God and with eternity.”


“Every second of the search is an encounter with God,” the boy told his heart. “When I have been truly searching for my treasure, every day has been luminous, because I’ve known that every hour was a part of the dream that I would find it. When I have been truly searching for my treasure, I’ve discovered things along the way that I never would have seen had I not had the courage to try things that seemed impossible for a shepherd to achieve.”


This is my dream. To practice medicine in the way that feels good to my heart, in a way that I know will help families and my community. To be unhindered by traditional systems such as hospital systems and clinic administrators. To collaborate directly with my patients and their families. To build sustainable relationships with families that help prevent disease and suffering. To be there for my patients when they need me.


Many thanks to KC and others for encouraging me and supporting me. A gentle nudge from her is what prompted this post. Even though it is scary, sharing such a personal detailed account on MiM, I want to share this new phase of my life because I have already received countless messages from colleagues, friends and family saying how much my business has inspired them to pursue their own dreams. I want to take you all on this new path with me. Let me know if there are particular topics about entrepreneurship and balancing work and life that you would like me to write about.


Thanks Mothers in Medicine for inspiring me!


Please follow my journey on social media:

Sunday, January 13, 2019

When it's time to get unstuck

Have you been feeling stuck? What are you going to do to get unstuck? Maybe start with your sock drawer? Or start with a vision board for your practice? Or start with a date night with your partner or a girls' night out with your friends. Or start with a breath. Whatever you do, just start!

For the last few years since finishing residency, I have been grappling with many things. After my disappointing first job as an academic pediatrician (my "dream job" I thought), and my foray into private practice I realized that the system of medicine many of us practice in, corporate medicine with the primary goal of seeing enough patients in the day, simply didn't fit with the what fuels my heart.

I spent two years during my American Academy of Pediatrics Leadership Innovation Fostering Education Fellowship researching physician wellness and in particular how systems and practices must incorporate wellness and burn out prevention at all levels. It is not enough to tell physicians to meditate if they are being "strongly encouraged" to see more and more patients, have burgeoning administrative tasks (click this meaningful use button), have mountains of debt, or are in jobs that they hate because of loan forgiveness, have less and less control over their schedules, and less time to make meaningful relationships with their patients. A mindfulness seminar won't cut it. Physicians everywhere are saying enough! It's to much! Record numbers of our colleagues are walking away from medicine or are joining the ranks of the hospitalists and specialists. What happens to our system when there are more hospitals, urgent cares, and intensive care units than quality, sustainable primary care practices? What will continue to happen when emergency rooms and surgical suites continue to be more lucrative than wellness centers and small, high quality private practices? Does it mean people will be allowed to get sicker and sicker? Does it mean that large hospital systems will continue to invest less into primary care and more into expanding their Emergency Rooms? Money talks, right?

This year I will be undertaking some exciting new endeavors. To try to get back to what inspired the premedical student who had all of the time in the world to sit with my patients, to commune with them, to build with them. We see it all around us. Patients who can afford it are flocking to naturopaths and integrative medicine doctors. The overwhelming response is that those providers listen. They have the time. So I have to make the time.

I have been hustling and working, but I still felt stuck. Stuck in fear. Stuck in a laundry list of things to do. Stuck in the what ifs. Stuck. So again, I use the tools that I have and start to research solutions. I have been listening to a lot of podcasts about following your dreams and reading books about decluttering and re-envisioning your life (see the list below). I even watched Marie Kondo's Tidying on Netflix. I saw the piles of clothes folks had and thought "yuck! How could things get so bad?" And then I did this while my boys are away:


(clothes stored in my closet, attic, and drawers - don't judge me until you try it! Very eye-opening!)

It's no wonder I feel stuck. I have been holding on to so much. I still have clothes from my first attending job and from my corporate job that I know I will never wear again. Letting go of them causes so many mixed emotions. Failure. Courage. Pride. Anxiety. Commitment.

It's time to get unstuck. The piles and piles of donations, maternity clothes to pass down, and work clothes to pass on won't unseat themselves. No one is coming to save me. I am saving myself. Starting right here. In this moment, again. And I will do it again and again PRN (as needed for those who don't abbreviate on their prescriptions). One day at a time.


Above references mentioned:

Podcasts:

  • Dreams in Drive
  • Side Hustle Pro
  • Therapy for Black Girls
Books:

  • Marie Kondo's "The Life Changing Magic of Tidying Up"
  • Dr. Dike Drummond's "Stop Physician Burnout: what to do when working harder isn't working?"
Blogs:

Netflix shows:

  • Tidying Up with Marie Kondo 

Wednesday, November 14, 2018

Keep your mama friendships guilt free

I have been so blessed to have several amazing groups of girlfriends, most of whom are mamas. I have a handful of dear friends from high school, sorority line and big sisters who have become like family, my college international housemates, my college friends whose spouses have become my husband's friends, beloved friends from our time in family housing at UNC, my Code Brown Crew from UNC Pediatric Residency, the mamas from the parenting group my husband and I started 3 years ago, and my family - I count my mother, mother-in-law, and great aunt as three of my best friends - these women fill my life with advice and love and accept my text messages and incoming calls day or night. I love, love, love them!

I truly believe that it takes a village to raise a family and it takes a tribe of girlfriends to keep a mama sane and thriving. Over time I have come to realize that it is impossible to be everything to someone and as such I have been able to find over time that all of the different qualities my girlfriends have make for some diverse, sound, and priceless advice. I have never been a one-best-friend type of girl even though I wanted to be and instead do much better with a cadre of lady friends. 

As our lives have ebbed and flowed, sometimes the calls are more frequent, sometimes months or even  years go by without communication. But the love is always there. After months of not speaking I have done consults on sick kiddos, talked to family members who had medical questions, done an emergency contraception consult for an adolescent volunteer visiting the United Arab Emirates (it is dangerous in many countries to have unmarried sex). I have walked with friends through infertility, infant loss, miscarriages, marriage challenges, spousal communication issues, school issues, health issues, you name it. 

As my life has become busier I have been doing more lately to immediately send a text when one of them crosses my mind. Just a quick "you ran across my mind, it's been so long, sending you a big ole hug. How are you and the family?!?". Which leads to a flurry of updates before we have to run. And if I really feel compelled and have some alone time in the car, I pick up the phone and call. Some of those impromptu catch up calls have been life changing for me and for the other ladies. 

I have incorporated a saying recently when the inevitable "I am so sorry it's been so long" is uttered. I quickly say something like "Girl!!! Our lives are so busy ain't nobody got time for mama guilt! Call or text me when I run across your mind and I'll do the same for you!" and then we laugh and continue to catch up in the few minutes we have.

So to all of the mamas out there. Call or text your friends when they run across your mind. When you talk, carry on where you need to. If you feel the need to apologize for it being so long, be gentle and forgiving with yourself and stop yourself! Let's minimize the guilt we have in our lives and do what we can when we can unapologetically. If your friend apologizes, tell her you refuse to have any guilt in your relationship when life is already so complicated and you promise to do what you can when you can to stay in touch. Here's to keeping your mama friendships guilt free and full of love! 

How do you keep in touch with your friends? How do you minimize guilt in your relationships? Please comment below!

Wednesday, August 22, 2018

5 months in - just breathe, just love!

5 months into being the mother of 2 little boys and I barely have time to breathe sometimes. I work as a Pediatrician but I had completely forgotten how very very very very very very (can I just type the word “very” for the rest of the post?!?) hard mothering a newborn is. Add to that some complications, a rambunctious, highly intelligent 6 ¾ year old, a husband 2 years into his tenure-track and 35-year-old bones and you have a recipe for fatigue that rivals the best of them.

5 months of cuddles. Of tears. Of such profound joy that it takes my breath away. For example, I remember the first time Zo told us how very much he loves his “baby bro” and how he’s his “best buddy”. Mothering for the second time has also been very humbling. When we found out that our little one was losing too much weight and could not exclusively breastfeed I felt like an utter failure. I KNOW how to breastfeed a baby after successfully doing it with our first and I thought if I powered through, me and Mau would get-it-done! But I had to come to terms with the fact that sometimes a mama’s body and a baby’s body just can’t power through, you just can’t will enough strength in his little low-birth-weight jaws to muster up enough energy to be a good breastfeeder. It took lots of letting go, lots of submitting to our reality. And y’all know I cry, a whole lot, so this made me weep and gnash my teeth like nothing else! But as I snuggle his now chubby little thighs, I remember the donor breast milk, the formula, the supplemental nursing system, the bottles, the reflux and I can smile. And it’s all okay even if it’s not what I envisioned.

So 5 months in, I know why my patients miss follow up appointments. Even with my father here with us almost full time I am inundated with Early Intervention, Cardiology, Ophthalmology, and other appointments. He’s perfectly and wonderfully made (took a while for me to be able to say this) but his little life requires a team for him to thrive. And thrive he is! We have all overcome so much and we have so much more to go. To all of the mamas out there in MiM land - wishing you and your babies so much love, health, and happiness. Even when mothering isn’t what you envisioned just remember that you and your baby were meant for each other. Learn all you can. Teach all you can. Be gentle with yourself and your baby.

5 months in. Inhale. Exhale. Smile. Inhale. Exhale. Smile. “The greatest thing you’ll ever learn is just to love and be loved in return” (Nat King Cole).

Saturday, March 24, 2018

Mau Man and the Chronicles of a Low Birth Weight Mama

BIRTH:
In early March, I became a mama for the second time. We have nicknamed our new little one Mau Man. Our home birth didn’t feel all magical like the pictures I see on the Internet but maybe after continued exposure to oxytocin while nursing I’ll change my story and in a few years I’ll tell you all about how magical it was (feel free to call me out on it!). It was intense and brief (he came within 3 hours but it felt like days). Similar to our natural hospital birth with our first Zo, the details are hazy and I feel traumatized. Did a human just burst forth from my body? Yup! He did. Did I feel like I would give up. Heck yeah, I felt like throwing in the towel a few times, but I didn’t. Was I scared. You bet I was! Did I feel powerful afterward? You know what, I sure did! And super tired too, just like with Zo. I feel like no matter where you deliver, birth takes over you, it takes hold of your being and you just have to submit to the intensity of the process.

LOW BIRTH WEIGHT, THE CONTEXT: Now we find ourselves with our newest little one who is healthy in every single way except he was tiny at birth. 2360 grams (or 5 pounds 3 ounces). Under the low birth weight cut off of 2500 grams. I have read countless studies of how Black women like myself, regardless of socioeconomic status, are at a higher risk of pregnancy complications, maternal and fetal mortality, preterm labor and low birth weight. At my Baby Sprinkle a few months ago, a group of my closest friends and I spent considerable time discussing this topic. Pretty morbid but we are all Black doctors, educators, and health care professionals. But somehow I thought, I would be insulated, I would be spared. I took my vitamins, exercised, meditated, saw a chiropractor twice a week. With all of the complications and losses friends and patients have had I realize that low birth weight is manageable but it still hurts. After our own loss last year, I realize that regardless of how small he was I get to hold him and touch him and smell him and snuggle him and nurse him and I will do everything in my power to get his weight up.

LOW BIRTH WEIGHT, THE COMPLICATIONS: Flash forward to Day of Life 3. His weight loss was more than what our Pediatrician and I liked and he was at risk of hypoglycemia and dehydration. He had a good latch but he just couldn’t muster up enough energy to transfer milk out of my breasts fast enough to grow. I had to start nursing and feeding him every 1.5 hours and start pumping several times a day to provide expressed milk to supplement him with. We worked with an amazing local Lactation Consultant friend first at our home and then in her office and started using a Supplemental Nursing System or SNS. This is a little tube that you attach to a syringe to feed babies at the breast or using a finger to help train them. This helps prevent nipple confusion by delaying the introduction of a bottle. Day of Life 4 was a blur with a ton of feeding and pumping. Day of Life 5 - he had begun to gain weight and his parents were exhausted. We were allowed to space him out to every 2 hour feeds. Day of Life 9 back to birth weight. Day of life 18 weight up to 6 pounds.

And this is where we find ourselves: Nurse and reposition the SNS 10 times. Pump. O finger feeds with SNS in the early evening so that I can sleep for a few hours (this is priceless! Many thanks to Lactation and our old school Pediatrician who made this a key part of our process). Smile. Cry. Have a melt down feeling guilty that I couldn’t make him fatter. Listen to a podcast. Take a lactation supplement. Play with Zo for a few minutes. Tell Zo to be gentle and not climb on me while I’m nursing. Get a pep talk from the hubby. Repeat.

I’ll keep you posted and can’t wait until I can throw this SNS out. I pray for the day he is exclusively breast fed and that breastfeeding soothes him.

My world at night: our 30mL  syringe, the SNS premature baby feeding tube, my 2 pumps - my Spectra electric pump for daytime pumping and my NatureBond silicone manual suction pump for easy night time pumping - I pop it on the alternate breast while nursing/SNS feeding. 



REFERENCES:
Adverse birth outcomes in African American women: the social context of persistent reproductive disadvantage. https://www.ncbi.nlm.nih.gov/pubmed/21213184
Black Women Disproportionately Suffer Complications of Pregnancy and Childbirth. Let’s Talk About It. https://www.propublica.org/article/black-women-disproportionately-suffer-complications-of-pregnancy-and-childbirth-lets-talk-about-it
Racial Discrimination and Adverse Birth Outcomes: An Integrative Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206968/

What’s Killing America’s Black Infants? Racism is fueling a national health crisis. https://www.thenation.com/article/whats-killing-americas-black-infants/

Sunday, December 3, 2017

this little wiggly squirming miracle in my belly

I just stopped on the MiM website when it dawned on me, I haven’t posted in 3 months?!? What in THE world?

I realized it’s because I’ve been holding my breath for the last few months. Putting all of my energy into cooking up a healthy baby. Doing my dag-on best to not stress and submit to this process of life after loss.

I posted in August that we are welcoming our second child. This little baby is now about the size of a butternut squash, just shy of 29 weeks and the third trimester. It wiggles and flips, squirms and dips all of the time. I’m in love.

I’ve been holding my breath. The first 12 weeks I fretted every time I used the bathroom with a prayer of “please no blood, please no blood, please no blood”. And there wasn’t any blood! 4 early ultrasounds later I knew this one was a strong one with a heartbeat like it’s big brother Zo (many thanks to the sweet Ultrasound Tech at my hospital and at my obstetrics office who let me see the baby’s heart beat so many times and hugged me as I cried each time). It’s been strong since it made its first appearance with my linea nigra at 3 weeks.

Balancing part-time work with a first grader and tenure track husband is no small feat. I am so thankful that pursuing medicine has afforded me with the ability to work part-time and still live quite comfortably. I am able to eat delicious, healthy food, attend prenatal pilates class weekly., see a chiropractor for my aching back and hips twice a week as prescribed, volunteer at Zo’s school, be the Parent Teacher Association Co-Secretary, and have days every week to myself with my favorite Netflix series (Supernatural season 4 of 28 and She’s Gotta Have It!). Though I am exhausted at the end of my office days seeing pediatric patients, I am so thankful for those days. I get to see my patient grow. They get to see me grow. And I am now getting advice from everyone about welcoming another baby into our world. I love my staff. I love my patients.

I love this little wiggly squirming miracle in my belly. Here’s to 10 more weeks of us being conjoined. Please stay healthy. Please stay healthy. Please stay healthy. You are so strong. You are so strong. We love you so much. We love you so much. We love you so much.

Friday, September 8, 2017

lamentations of a community pediatrician

I am tired of hot cheetos. I am tired of juice and kool-aid for toddlers. I am tired of pizza or and wings from the local takeout. I am tired of 1 month olds being given 4 ounces of formula with cereal in it to “help them sleep” and the school aged children drinking milk or chocolate milk with every school meal even though they don’t really like the taste of it. I am beginning to see more and more 200 pound 12 year olds and 80 pound 6 year olds.

It is Well Child Check season in the land of pediatric primary care. As a private practice Pediatrician in Washington, DC I don’t actually eat those foods myself or feed them to my child (though I do love pizza and wings once a month) almost every single patient I see with elevated body mass index or abnormal increased weight gain has had or currently has some part of this in their diet.

I am beginning to worry every day I am in my office about all of the premature heart disease we are going to see in 20 year olds because I now have seen close to 10 school aged children with abnormal lipid panels due solely to their poor diet, I have seen more than my share of toddlers and school aged children with developing Blounts Disease (this is a disorder kind of like deforming kiddie-arthritis where the bones in a part of one or both knees begins breaking down due to excess weight, causing deformity of the knee), I have seen countless young women with metabolic disorder and polycystic ovarian syndrome (think bad cystic acne, hirsutism, abnormal and often heavy periods). I have seen more than my share of rotting teeth due to prolonged bottle use, inadequate teeth brushing, and poor diet high in sugar-laden beverages.

Every day I say or type in my instructions to countless children and parents “no juice, soda, sweet tea, or koolaid, it’s bad for your child’s teeth and behavior” and I cannot tell you the number of children and parents who argue that juice must be good because “WIC (Women, Infants and Childrens Program) gives it to me”. Or the kids that say “I don’t even like milk, but school gives it to me at breakfast and lunch so I just drink it”. Ohhhhh WIC and schools! If only we could divest ourselves of the sugar and milk lobby and give these kids what they need - gasp, WATER! Water, the only drink that other countries, with much lower rates of childhood obesity than the United States I might add, allow in their schools. It literally takes me a several minutes in most visits to share with parents that no juice is definitely not healthy even though it has “vitamins and minerals” and that no it’s not the same as eating a piece of fruit. And no, if your child doesn’t like milk they don’t actually have to drink it and they can just drink water and get their calcium from things like yogurt or cheese. And no, chocolate or strawberry flavored milk isn’t needed because if your kid doesn’t like milk he/ she really doesn’t have to drink it. And yes, the sugar in juice and chocolate milk is just as bad in it as the sugar in soda is and nope I don’t allow my 6 year old to drink juice, soda, sweet tea, or koolaid (except at the random birthday party or when he is with my family who simply won’t listen to me) and nope my 6 year old doesn’t drink cow’s milk. Seriously, I can recite these points in my sleep because I say them every day countless times.

My heart hurts. The ICD 10 codes: abnormal weight gain, childhood obesity, pediatric BMI greater than 95%ile dot the majority of my notes. Cutting out the “juice, soda, sweet tea, and koolaid”, cutting back on the take out, increasing the time outside or dancing and playing, and cutting out the cow’s milk would be enough in most cases to curb this trend.

We had a new neighbor in his mid-30s die of heart disease this summer. His obituary showed a child who has struggled with his weight since early childhood and multiple relatives with obesity. His story includes hypertension and pre-diabetes in his 30s. This story is going to be more frequent if there isn’t major policy and cultural change in America.

Thankfully I have had a handful of success stories and they keep me inspired to share healthy diet and exercise with all because honestly so many of my patients just don’t know. The toddlers who I have done intensive intervention with in my office and referred to our local childhood obesity program whose entire families have adjusted their diets and their weight gain has slowed and can run and play more. The adolescents who have lost weight since their last visit who walk in with their parents who are looking mighty healthy too and tell me about the weight they lost and how they no longer drink sweet tea every day and do take out much less. The mothers who breastfed for a few more months even though it was hard. The families who stopped giving their 2 month olds rice cereal in their formula (of note, the current recommendation is exclusive breastfeeding until 6 months old unless medically contraindicated. No supplemental foods - that includes rice/oatmeal cereal until the kiddo can sit up on his/her own usually between 4-6 months).

So while I lament, I press on because there is so so so much work to do. Now off to find a healthy early morning and I can’t sleep blogging snack for this 4 month old growing fetus of mine.

Monday, August 21, 2017

clocking

I have never been one to track my periods, but then life happened and now I am tracking them religiously.

I think back to when it all began. I was one of the last of my friends to get my period. Even though my mother had prepared me with books and talks, I still thought death was imminent when it started. So once they occurred regularly, I just went with it. No charting. No tracking.

Fast forward to my mid-twenties as a medical student. My husband and I decided to have a child before starting residency because it seemed like a good plan. Thankfully Little Zo established himself promptly after discontinuing my IUD. 3 weeks after. I had little knowledge of how truly a blessing that was.

And then life happened. The stories of loss and infertility began to trickle in. A cousin whose first child was conceived in our 20s using in vitro fertilization and who is still paying bills for it; she has been trying for years for baby #2. The friend and aunt who have both suffered multiple miscarriages. The friend who experienced a molar pregnancy and had to consider radiation therapy. The best friends who suffered a stillbirth that I wrote about here: http://www.mothersinmedicine.com/2013/07/life-loss-and-celebrations-of-love.html

Once settled into attendingdom, O and I decided to try again in order to give Zo that sibling he sometimes mentioned. I wrote in my post on December 29, 2016 entitled “(all is not) lost” about our miscarriage (http://www.mothersinmedicine.com/2016/12/all-is-not-lost.html). It was devastating.

And now, without even realizing it, I have begun tracking my cycles. 3 after the IUD was removed and then we were pregnant with number 2. And then the miscarriage.

My D&C surgery was in January 2017. And every month thereafter I prayed my cycle would return. Was that pinch the beginnings of my cycle? Was that the beginning of ovulation. 3 months later, my cycle returned. And each month that went by we still weren’t pregnant. And then. Last menstrual period May 17, 2017. We are overwhelmingly happy, frightened, joyful, petrified, and elated. Big brother Zo is happy. Thus begins a new clocking of days, weeks, and trimesters. Second trimester begins this week. So thankful.

Monday, June 5, 2017

Tell the truth, as soon as you know it

It was a Thursday evening and I had just gotten off from back to back shifts, first a full day in private practice and then a hospital training for my new gig. Zo was riding his bike up and down the street. My husband O catches me on the porch and says, “have a seat, I need to tell you something”. My heart sank, I knew this wasn’t going to be a good conversation. He proceeds to tell me about how Zo had stabbed another student in the neck at school. This is one of those students who is always crying, always dramatic, always asking for a hug. The student had cried and gotten a band-aid and Zo had gotten in big trouble.

I began crying. Ashamed. Scared. Worried. More shame. Guilt. Fear. I had flashbacks of when I had gotten into a fight in high school and the look of worry and concern on my parents’ faces. I didn’t understand then, but in that moment, I fully understood. You work so hard to raise well-rounded, empathetic, gentle humans and then they go and do something so utterly stupid that you lose your breath, you lose all sense, you feel like a failure.

O proceeded to explain to me how he had managed it. He decided to handle it while I was at work between the men-folks. He had picked Zo up early. He had talked to him first and then he even met with the the School Psychologist, Assistant Principal, his Teacher, and the Teacher’s Aide. My husband had cried once they returned home due to fear, shame, guilt, and an outpouring of emotions. He called one of our friends who has an 8 year old son and they walked through an appropriate discipline plan. O talked to Zo a lot and explained how we have to have “gentle hands” all of the time. By the time I got home things were smoothed over. I was saddened that yet again I was at work, but I was proud of my husband for the way he handled things. O is the more calm and collected parent and I begrudgingly admitted that it was good that he was the one who had picked Azola up.

Zo finally came down the street and saw me on the porch. He came to give me a hug and then put his head down and said “did you hear about my behavior?” and then we talked about how he had hurt his friend at school. I explained that I was very disappointed. He promised never to do it again.

I texted the other parent, a stepmother, who had been a little flighty in the past. I asked if we could talk about what happened and we set up a time. That time came and went. I reached out again. Same thing. Apologies. The weekend went by. We continued to talk to Zo about being gentle and that it was important never to hurt others.

Then on Monday I get a text from Zo’s teacher asking had I heard what really happened. I quickly texted back and learned that Zo HAD NOT stabbed another child in the neck, but that on Friday they had learned from the stepmother and father of the little boy ON FRIDAY AFTER SCHOOL that Zo had been dared to break a plastic fork and that a tooth of the fork had popped up and hit the other boy in the neck. The kids had thought this meant that Zo had stabbed him.

So after an agonizing weekend feeling like failures of parents, all the stepmother had to do was text me and say something like “hey, you know Zo didn’t really stab my son, right?” and that would have changed things considerably. Zo wouldn’t have been disciplined. Why didn’t the family tell the truth as soon as they learned it? I would have! Why schedule a time to talk and then miss it and not say anything?

I wish those parents had told the truth as soon as they’d known it.

Thursday, April 20, 2017

a review through the year(s)

I cannot believe it has been almost 4 months since I wrote the post about my miscarriage, 1 year since I left a toxic work environment and dove into health care leadership, 2 years since residency ended, 5 years since becoming a mommy, 12 years since graduating from college, and almost 30 years since I proclaimed that I wanted to become a doctor.

Through it all I have learned so much and I am truly indebted to the colleagues and mentors who have helped me craft this career. I am even more so indebted to my loving husband and family who constantly teach me that my happiness is worth it and at the end of the day, a job is a job, is a job and when you aren’t in your job, the job goes on, the world does not end.

Motherhood changes you. Partnership changes you. Medical training changes you. Motherhood in particular, puts a new perspective on things. And in my opinion, it makes you question things that you had never questioned before. It makes you prioritize in ways that you hadn’t before.

For example, for my whole life I’ve known that I wanted to become a doctor. I never waxed nor waned in that belief. Though it was hard at times, I knew I would achieve that goal and I did. But I also realize that it might not have happened. My heart cries for the countless young medical students who don’t match into residencies. For the countless applicants who go into super extreme debt to attend post-bacc programs or use private loans to finance medical educations in international schools (I know far too many!) and then to not match?!? I can’t fathom that. But that could have been me, could have been any of us. It has happened to some of my friends. But now as a mother as I reflect with other women physicians, so many of us question our decision. In particularly frazzled moments, we say emphatically that it was not worth and we would not do it again and we would discourage our children from pursuing medicine. What was it that shifted our beliefs? Was it aging? Was it pregnancy hormones? We may never know.  

I started residency with a newly crawling baby. I began questioning things that I had learned, that seemed so dichotomized, so absolute because caring for my snuggly little Zo taught me that everything and I mean everything is shades of grey, covered in drops of breastmilk and smeared in shea butter and kisses. There was no more black and white,no more textbook answers to lull me into a false sense of security.

And the changes continued, each moment and each role took on new meaning. Weekends off from work took new meaning. I had a baby to raise and learn and love. I had an amazingly supportive and successful husband to dote on and love. Each moment became more precious because when I was at work, I had to completely be present caring for and keeping alive someone else’s baby. Time at work took on new meaning. Every time things got rough, I would say to myself “this is someone’s baby! This is someone’s baby! Do your freaking best! Love up on this family and this baby! Do the right thing by this baby!” and it worked. I was able to care for countless patients and their families.

I started my first attending job. The one I knew was going to be my dream job. And it wasn’t. From the very beginning. The burn out was palpable among my partners, the check in staff, the medical support staff, the nurses. In my first few weeks, I was warned by various members of the staff to literally “get out” before the patients lured me into staying forever. I didn’t know how to process it. This was my “dream job” at my dream institution, a top 10 children’s health system in a highly desirable area. The one that I was supposed to stay in, rising through the ranks, being a tireless advocate for my patients and their families. But I looked around at the colleagues who had trained me as a medical student and no one was happy.

Everyone was raging against the machine of big-institution medicine without the tools they needed and without the support of the administrators. There were partners who were months behind in charting on the outdated electronic medical record. There were partners who worked hours from home each night and who spent more time charting than seeing patients. There were incompetent team members, difficult to work with management, and mountains of red-tape and bureaucracy at every level and it frustrated us to no end! We were understaffed at every level but the message from the higher ups was “do more, see more patients! You’re not meeting your numbers!” while we providers questioned the safety and quality of fitting in another patient, of overbooking overbooked slots, of opening earlier and closing later. This scenario isn’t unique. I hear countless stories from other physicians in private and academic medicine, from friends working for nonprofits, I could go on. And when you hear it from so many people in so many industries, you realize that we are all workers. We all struggle with the same things, but it is up to us to find our niche, our space where we can deal with the “particular brand of crazy” of an organization.

My mama heart made me extra courageous, extra fierce. I began to network and met a group of other outstanding physicians many of whom were mamas who had experiences just like. They found the strength and courage to craft professional lives that were more in line with their beliefs and their experiences gave me strength and I began to let go of the made up dream as I began to develop a new dream.

If it weren’t for my husband and my family, I never would have had the courage to leave. But I did. I spent countless time and even significant money on legal fees fighting and it’s not even over yet (always, I repeat, always consult with an employment lawyer early when you first begin to worry about retaliation or have safety concerns, just do it! Human Resources works for your employer and unfortunately not really for you). But you know what - MY HAPPINESS IS WORTH IT! I trained too long and too hard to not be valued, to be underappreciated and you did too! We are worth it. We must advocate for ourselves and our happiness as a matter of survival. Physician burnout is on the rise and unfortunately so is physician suicide. Your life is worth it! You should not be miserable in your job! Being a mama made me more courageous. What would I tell Zo if he was going through this? I would tell him find a new job, it’ll be okay! You’re worth it! I know they tell us it’s our calling and although that may be true - a job, is a job, is a job!

This last year in part-time health care leadership coupled with part-time direct pediatric primary care has been a whirlwind. Scary and beautiful, overwhelming and exhilarating. Exhausting and empowering. I have been getting my lean-in on! And the view from my first big girl office is the bomb!

And because I have been courageous enough to sit myself down at the big-kids’ table I realize that we really do have expertise when allow ourselves to do what we are good at. Working with a major managed care organization, I understand why providers are asked to check off certain boxes in our patient assessments and I realize that this information must get back to the providers.  I realize how essential physicians such as myself are in re-envisioning health care.

Everyone has a boss, every organization has a parent organization and auditors to respond to. The system is such that major revision is needed to truly improve outcomes. Though my overall happiness has increased tremendously, the job is still a job. And I don’t think enough physicians, especially those in training, fully grapple with that. You still have people who are burned out; though honestly, much less here in my new office. You still have issues with incompetent people and I had to terminate my first staff member a few months ago. But “this particular brand of crazy” is one that I can deal with and is one I am thriving in. It’s one that my family can deal with.

Thank you for sharing in my self reflection.

Have you done your own personal review lately? If so, please share. What have you learned? How have you changed?