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

Monday, June 29, 2015

Moving and credentialing are like oil and water

The last 3 months my husband O has been packing while I have been working on getting credentialed. His boxes are brown and filled with books and mine are checkie-boxes that I slowly work through. His boxes move us toward relocating while mine push us further and further away from our goal of saving money ($731 for DEA license, $130 for DC Controlled Substances License, the list goes on and on) but closer to my first job as a Pediatric Attending Physician.

The only one of us who has had fun packing is our almost 4 year old. His favorite activities include: throwing empty boxes, making forts out of boxes, and sliding on boxes. One day O and I heard a loud crash as he and his friends decided to pack his room; they did a pretty good job of placing all of his toys in a large box and then they proceeded to drag it into the hallway so he could move. It was endearing for about an hour until he began rummaging through it to get toys that he now decided he just had to have.

I am writing now so that I can take a break from packing another box of dishes. Packing dishes has helped me realize that we have a ton of dishes we don’t even use. I am purging these unused items because I refuse to pack them and I’ll be happier with less clutter. We have made so many trips to our local donation center I cannot even count them and each time I wonder where all of this stuff came from, while controlling my desire to “just hold on” to that thing I haven’t used in months but that I absolutely “need” (like the expensive Dr. Brown’s baby bottles, they are totally keepers!).

The last 3 months have shown me that working, while doing on-line orientation modules and handling credentialing just don’t mix. There isn’t enough time in the day. Thankfully, credentialing is all done and in less than 3 weeks I will be a full-fledged Attending Pediatrician! Unfortunately our movers come in 3 days and I now can’t seem to motivate myself to press on and I have no more credentialing to use as my excuse. It’s game time. Relocation here we come! But for now I’m just going to sleep.

Monday, May 25, 2015

The end?!?

This morning I walked into my final official overnight call shift of residency. It is surreal to think that just 3 years ago, I began residency. I had absolutely no idea what it took, but having been a pretty good medical student I thought, “I can do this!”

Premedical studies, medical school, marriage, motherhood, and now residency have taught me about my ability to persevere, to thrive, to love and be loved. More so than the extreme highs and lows that come with providing care for a broad range of children from the critically ill to the chronically affected, you realize it is the day-to-day provision of care that is the most long-lasting. What you do on the average day at work, if your colleagues feel supported or unsupported, if your work leaves patients feeling cared for, if you managed whatever major things they were seeing you for, that’s what matters the most.

I think at the end of my shift tomorrow I’ll do a little happy dance to mark the end of an era. I am a lover of daytime work, of seeing the sunshine in the morning, of being at home when my family wakes up. I gladly mark the end of leaving home in the dark and trying not to wake up our toddler as I hustle to find my shoes. I gladly mark the end of back-to-back consult calls from the Emergency Department or outside hospitals for admissions. I sadly mark the end of seeing my favorite overnight nurses and of running efficient rounds. I sadly mark the end of being the “Senior Resident on call” answering questions for outside providers.

The end of residency overnight inpatient call and the beginning of Attending at-home call. Sounds nice to me.

Monday, April 20, 2015

Hurtling toward the next phase


I have searched but I cannot find the flying trapeze story I read a few years ago that explains my life, so I’ll paraphrase and add to it here:

I swing back and forth preparing for my next take off. I have prepared, but I know that this leap is longer and more challenging than ever before. In spite of a long line of successful jumps, there have been some near-misses, some full on misses, some blood, scrapes and even some still healing deeper wounds. This time I jump, my husband is watching and waiting readying himself for his jump into dissertation land and as we prepare Zo waits by ready to take off with us.

Well MiM friends, it’s official, I have accepted a position as a Pediatrician in my dream clinic. I’ll be back in DC working at an academic center-affiliated community clinic. I did my community pediatrics rotation there as a medical student and so many of my respected supervisors and medical school friends are still there.

Interviews were a whirlwind. I met so many nice people, got lost countless times, learned even more about what I need, want, and will compromise on.  

And now onto school finding. Every day I have a mini-freak out when I think about Little Zo starting pre-k. Our cherubic toddler has been replaced by an almost 4 year old hilariously funny and extremely sweet rib-protruding knock-kneed ball of energy. And then I freak out more about making pick up and drop off work and I pray so intensely that we find the right environment for him and that we will find balance so I can rock my boards and O can finish his dissertation expeditiously. I wish I could transplant his daycare to DC.

And house hunting on a single income in a very tight housing market is not my favorite thing to do but I guess house hunting without the beloved Property Brothers will always be lackluster. We have several leads on promising houses and are heading up next weekend prepared to make an offer. Can’t wait to have our first home secured and then on to do-it-yourself projects for years to come.

This jump seems epic. Push-pull-push-pull, forward backward forward backward, take off.


Tuesday, March 10, 2015

Career poll: if you weren't a doctor, what would you be?

Since beginning my clinical rotations as a medical student, I have been exposed to so many interesting, dynamic jobs within health care that I never knew existed such as Recreational Therapy, Occupational/Physical Therapy, Respiratory Therapy, Doula, Midwife, Lactation Consultant, Clinical Social Worker, the list goes on and on.


As someone who regularly follows MiM guest posts and who talks to many premedical students, I always find it interesting that exposure to other fields in medicine is so lacking. There are so many different ways to become a health care provider and though Doctors are among the highest in the hierarchy, without a diverse group of providers we not only fail to provide the best service to our patients, but we often fail to address core issues that determine health outcomes. 

With that said, for the physicians around:
  • if you weren’t a doctor what medical professional would you be or would you choose a completely different field?


And for those in training:
  • what other careers in medicine have you researched, considered, or shadowed in? What did you think?


My answers:

  • If I hadn’t become a doctor, I would be a Recreational Therapist with a focus on alternative methods such as massage and reiki or a Doula/Health Coach/Life Coach/Interior Decorator
  • Prior to my training, I didn’t really spend time shadowing Nurse Practitioners or Physician Assistants but should have. I will be entering academic community pediatrics in an urban setting and the overwhelming majority of my mentors and folks whose careers inspire me are Pediatricians. However, if I was interested in more community or rural medicine, pursuing a career as a  Nurse Practitioner or Physician Assistant would have been a possible alternate route to providing primary care with much less debt and better work-life balance.

Monday, March 2, 2015

In between promise and fatigue: here's to the end of residency

“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.”

“Before a dream is realized, the Soul of the World tests everything that was learned along the way.”

“Every search begins with beginner’s luck. And every search ends with the victor’s being severely tested.”

I can see the end of residency. My schedule is set. I know that June 23 is my last official day of my pediatric residency. I am standing on the edge: the edge of my time as a “trainee” and the beginning of my time as an Attending Pediatric Physician. As one of my closest mentors says, “Medicine is about delayed gratification,” and she is so right because I can feel the end of training, it’s palpable. It stands looming in the distance. I see the promise - the chance to continue to create the career that I have envisioned for so long. One committed to the underserved, adolescents, and new families. One committed to medical student education and helping to forge a path in medicine where the marginalized student feels less alone. One committed to enhancing trainees understanding of health literacy, compassionate care, holistic care. One committed to clinical excellence and rigor.

I can feel the promise of creating a career where I can share more of the child-rearing responsibility with my husband. We have had the chance this year to experience up to 2 consecutive months of me having a “regular” or non-Ward schedule and it has been amazing (family dinners, weekend outings, dates, sleeping in). My Attending friends tell me that this is how life can be post-residency and that I have to work hard to get a schedule that allows us to feel more like a regular family. Interviews have been going very well, but none has felt quite like “the one.” I can feel “the one” coming though and am giving myself until April to keep searching and networking.

But I can also feel my fatigue. It also stands looming and sometimes sneaks in for a jab or two. The tight pull of my neck as I continue to type into our electronic medical record. The beginnings of a tension headache as I work on licensing applications during Zo’s nap time. I can feel my strain and my friends’ strain as we begin conversations about our final residency rotations with “I am soo over this!” Invariably all of our texts, phone calls, and in person conversations include our “being over” being on call, covering in the wards, and Interns doing crazy things. Then we laugh and talk about how a friend who is a new Attending has told us something wonderful about his or her life.

As my Residency Director said, “You’re not supposed to love residency” because it’s not a permanent job, it’s just a big hulking stepping stone.

As I always do when I am straddling a new transition, I have begun to re-read selections of "The Alchemist." This book has been with me since the first time I read it in 2004 as a fourth year undergraduate awaiting medical school acceptances. This road has had its share of suffering. Times where I felt failure was imminent. I fought on. In spite of a few very low points, I have experienced joy beyond what I ever could have imagined. Providing excellent patient care, figuring out diagnoses, being hugged and hugging amazing families and assisting them during their lives’ lowest points. I have experienced the joy of getting married to an amazing man that I now call my own and together we welcomed to the world an outgoing, rambunctious little boy that amazes us every day. There isn't a day that we don't pause, smile or laugh out loud and shake our heads at his silliness and love for life.

As I stand on the edge of my most recent life’s transition, I foresee some suffering, some testing, and a whole lot of joy. While I welcome luck, I also know that I have been fortified by life’s challenges and know that you can experience fatigue and promise simultaneously and it still bring so much joy.

Here’s to the end of residency!!!

Quotes above are from Paulo Coehlo's "The Alchemist," 1993.

Monday, February 2, 2015

"You're full of it"

I have read countless articles about how medical trainees have been berated and belittled, yelled at or pushed. I have never in my years of training felt that way or been treated that way. Yes, I’ve been questioned strongly. Yes, with lines of questioning sometimes called “pimping.” I have felt like I needed to study for 40 more hours and have gone into the bathroom afterward to cry, but I’ve never been berated. I’ve never been pushed. I never even thought of what I would say or do in those situations. I have heard my share of racist and sexist remarks and have found ways of addressing it directly and highlighting to the team why it’s unacceptable. But what would I do if someone directly belittled or disrespected me? Would I cry? Would my knees buckle? Would I yell?

Well, that all ended when a Pediatric Surgery Attending told me, “You’re full of it” in front of my staff while I was working in the Pediatric Intensive Care Unit. This particular Surgeon has a history of yelling at Resident Physicians that I learned of after the incident. That night, I was caring for a postoperative patient who had just left the operating room. During interdisciplinary sign out I asked for clarification of a medication dose as I was preparing to enter routine orders such as for PCA-administered pain medicine. The Surgeon turned and said, “No, we will enter the orders” meaning the Surgery Residents. I told him that in my experience PICU Residents enter the orders and manage the PICU patients. He said, “No, who trained you, this is my patient?”  I looked around and of course, everyone was staring at their feet. I was in my second month of PICU service and had heard countless times how our unit was a “closed unit” and that we managed our own patients, but this gruff, aggressively self-confident, tall male Attending with salt and pepper hair and a fresh tan was staring me down. I said, “You will need to speak with my Attending because this is not what I have been trained to do.” He turned, stomped away, and snuck in a low, yet completely audible, “You’re full of it.”

I stopped in my tracks and said more audibly, “Excuse me, but you just said ‘You’re full of it.’”I paused, collected myself and continued: “I feel very uncomfortable, and that was disrespectful. It is not appropriate to speak to trainees that way. I only want to provide excellent patient care.” He froze. When he turned around he had a look of utter contempt and disbelief; it was like no one had ever told him he cannot speak to people that way. His eyebrows furrowed and he spit out, “Well, I’m sorry,” and turned around. At that moment, my Attending arrived and my Fellow said, “Well, I’m glad you said it because I was about to.” I quickly excused myself as my hands began to shake and the pounding in my ears began to dull everything else out. I exited the unit, and sank onto the bathroom floor and cried. Big crocodile tears as my grandmother would say. I was anxious and nervous, but I was damned proud of sticking up for myself.

My PICU Attending found me later and asked me what had happened. I explained the facts and he shrugged and said, “I’ve heard worse,” and told me something about how that Peds Surgeon had cursed at him during his Residency. I told him that I hadn’t heard worse and had never experienced that type of behavior but that I thought it was unacceptable to speak to any member of the team that way. He shrugged and said he would address it with the Surgeon later. As I entered the Unit, the Nurses individually applauded me for speaking up the way that I had. I asked a trusted Nurse mentor if she thought I handled it well and she said I nailed it, and my Fellow echoed the sentiment. I didn’t get emotional, I said what I needed to say, and kept it focused on the patient. One of the Peds Surgery Chiefs came up to me later and had heard about it and gave me a quiet nod of support. She agreed that Surgery Residents who did not spend the night in the hospital should be consulted but they shouldn’t be the ones putting in orders since the PICU Residents are the ones who stay in house overnight. It’s a patient safety issue.

Many thanks to a different fabulous PICU Attending who a week earlier coached us on working in uncomfortable situations. She told us to use words such as “uncomfortable” and “unsafe” and keep things focused on the patient. Without her words, I probably would have shut down, my knees buckled and I wouldn’t have been able to say things in a way that would have gotten any response from that Peds Surgery Attending. I still believe, “You’re full of it” has no place when we are caring for patients.

I spoke on a panel earlier this year sponsored by the Student National Medical Association. They asked a group of underrepresented minority Attendings and Residents to discuss discrimination in medicine. I shuddered as I listened to the horror stories the Black and Latino Attending Physicians recounted. I think I would have quit if I had to endure the downright hostile environments they practiced in in their early careers. I don’t discount the real experiences highlighted by other trainees around the country and applaud them for their candor in sharing. I hope that we all are continuing to work so that abuse and disrespect are not allowed, and when they do occur can be apologized for and learned from.

Friday, January 2, 2015

Princess Service

“Your Princess Service has arrived.” At the end of my holiday shift, those words uttered from the lips of my Dream Guy, were like music to my ears.

I just completed a 6 day holiday shift working what our residency program has deemed WARS (working at reduced staff). You work up to 6 shifts in a row and get either the week of Christmas or New Years off in addition to your 3 weeks of vacation. I gladly got one of my favorite inpatient services with the Division Chief that I most admire. However, after morning 3 of waking at 5am to arrive for sign out by 6am, I was tired, my feet hurt, and I was forgetting what sunlight felt like on my face.

Three years into residency, our family knows to plan for rough stints like this and to have extremely low expectations for how our house will look (though I am so ashamed about how cluttered our bedroom is and bemoan its state daily with apologies). My in laws came into town on day 1 and are staying for 4 days after.

My day of work ends with O calling and making some silly joke about my “Princess Service”. The staff members here call being picked up or dropped off from work “Princess Service” and O has added it to his lexicon. I don’t think he quite knows that it is one of the highlights of my day.

I have arrived home daily to Zo playing on the floor with his grandmother with blocks or making Playdoh cookies, a glass of wine waiting for me, and delicious vegetarian fare cooked by my in laws or my husband. By around 8pm I can be found in my pajamas nodding off on the couch while someone else does the dishes. I somehow make it through story time and have been in bed by 9:30 or so every night. O and I watch our new favorite on-line miniseries, this month it’s American Horror Story, and I pass out.

WARS has ended and I begin the next part of the end of this year, applying for my medical license in the 2 states that we would love to end up in, and preparing for my next interviews.

Here’s to all of the Princess-Mommy-Doctors out there. I hope during this holiday season you feel the joy I feel each time I hear “Your Princess Service has arrived.”

Thursday, November 20, 2014

Vacation sans bebe

I read a few articles recently about Americans and vacationing. Of the only 25% of Americans who have paid vacation days, they have an average of 3.2 days left unused each year (OECD, 2013).

Unused vacation days. Not us!!! We use them all up. Zo travelled with us for the first close to 2 years of his life. However, once he was weaned and could no longer be lulled into a breast milk-induced-coma, we began planning trips without him. Many thanks to my parents and in-laws. And thanks to my cousin for letting us use her timeshare to enjoy fabulous, affordable vacations.

Here is my chronicle of our delectable and delightful second Vacation Sans Bebe, New Orleans style. I will focus on the food because New Orleans has to have some of the most amazing, creamy, luscious, sinful, gluttonous food around and there is just too much to write about (the wonderful people, the outstanding architecture, the cultures, the alcohol).

Best brunch ever - I can’t tell you how much O and I love an excellent brunch. My Sorority Sister B and her husband R who work for a major oil company in Louisiana met us at Slim Goodies. The french toast below was the best I have ever had; crispy French bread crust, fluffy middle, dusted with powdered sugar, and drizzled with syrup! Paired with mimosas that you prepare yourself (orange juice from Slim Goodies and prosecco from a neighboring restaurant they have an arrangement with), it was amazing!

(scrambled eggs, french toast, and large mimosa from Slim Goodies)


Best lunch - oooooh oooooh oooooooh. Gumbo and crawfish at Cafe Reconcile. Amazing nonprofit organization that trains local teenagers and young adults for careers in the restaurant business. Wonderful staff. Delicious food. The crawfish sauce was so complex yet not overwhelming. The grits were soft but had some substance to them and were perfectly seasoned.

(crawfish on grits, from Cafe Reconcile)

And the tie for best dinner - Bacchanal Wines and Houstons.

Bacchanal had to be one of the most fun experiences. We took a taxi into the Ninth Ward past factories and train tracks and end up in a cute neighborhood. You see a line on the corner entering a house with a big fenced in yard. You enter what may have previously been a living room, but has been converted into a wine and cheese shop. You purchase a bottle of wine, get a cheese plate (we unfortunately didn’t order one and the line was too long by the time we wanted some cheese), and go find a table. There are at least 100 people sitting and standing around. There is a live band playing in the courtyard. It is magical.

My husband and I failed on our first attempts to find a table, finally separating while he waited in the 20 person long food line and me making googly-eyes at folks with finished wine glasses taking up space. Finally, a very nice retired couple took pity on my and told me to pull up an empty chair. We sat at a candlelit table talking and drinking until they left.

And then the CHICKEN arrived.

Notice how I put that sentence on its own line. I had confit chicken that literally melted in my mouth with bok choy and a yummy carb I can’t remember. I did a little research on what confit means; it is to cook meat in oil at a low temperature (it’s not fried, it like melts away, oh goodness, soo yummy). That chicken was soo freaking good I am hungry just writing about it; the skin was crispy and perfectly salted and the chicken literally fell off of the bone and just melted in my mouth. O had a grilled tilapia that was equally divine. For dessert we had dark chocolate drizzled with olive oil and sea salt with even more wine.

(courtyard at Bacchanal Wine, image from http://fleurdelicious-nola.com accessed 11/1/2014)

Beignets - and on our last night in NOLA, we toured the city, stopping in shops. Eating. Drinking alcohol-containing beverages in plastic cups while walking (crazy that you can do that legally in NOLA). We ended the night on the banks of the Mississippi eating beignets from Cafe DuMonde with B and R. We heard approaching music as a first-line band leading a wedding party approached. As is the customary, we all stood up and joined in dancing and singing “As the Saints go Marching in” under the twinkling night sky.

Here’s to the best vacation sans bebe, NOLA, we love you bebe!


(Voodoo Tour, St. Louis Cemetery #1)



Our recommendations for excellent food in NOLA:

Slim Goodies, Cafe Reconcile (weekday breakfast and lunch only, nonprofit that does job development and career training for teenagers and young adults in the Garden District), Cafe DuMonde, Houstons, and Bacchanal Wines (get there early and just go ahead and get the darn cheese plate!).

Of note, I have no conflicts or disclosures, we went everywhere based on recommendations from friends and paid for everything ourselves. All pictures were taken by me and O unless otherwise mentioned and cited.

References:

An Assessment of Paid Time Off in the U.S. Implications for employees, companies, and the economy. Accessed Oct 16 2014.

Center for Economic Policy Research. No-vacation nation revisited. 2014. Accessed Oct 16 2014.

Work-life balance. Accessed Oct 16 2014.

Saturday, September 20, 2014

Birthday Call: from zero to 60 and then somewhere in the middle in mere hours

40 minutes into my commute to work, I had a pseudo-melt down. As I sang “Happy Birthday” over the phone to my three-year-old, I lost it. I realized that I hadn’t kissed him on his birthday, I’d forgotten my lunch and during a 28 hour call the cafeteria food begins to make me nauseous, and that I was exceedingly anxious about all of the changes our lives will encounter over the next few months.

Needless to say, I’m in the call room after a deluge of discharges, awaiting our next transfer, feeling the urge to write and release this tension.

My Little Zo is three today. Three years ago, on this day, I birthed a fabulous little human being into the world. He’s helped me grow in countless ways. I’ve learned to let go. I’ve learned to give my all in the moment and then pass things off to someone else (to hubby O, to my parents/in-laws, to the wonderful ladies at daycare, to his Pediatrician). I’ve learned that keeping your own kid alive and occupied means breaking lots of rules (my infant slept on his belly after weeks of sleepless nights, my 2 year old ate yogurt and spinach smoothies or oatmeal for dinner on picky-eating nights) and that I am so much more capable than I ever thought imaginable. I’ve realized what’s important (playing legos and dinosaurs before bedtime and leaving my notes until he’s gone to bed, sleep, couple time, giving my all at work and not worrying about my child since he’s taken care of at all times).

In less than a year, I’ll be an Attending and yet another goal will have been achieved. I have had a few successful telephone interviews and I have my first in-person interview in October with a community health system affiliated with my medical school. This morning when I was sobbing, a great friend, KJ, who is now a Pediatrician in private practice gave me her pep-talk. We have these at least once every few months. She tells me about all of the little and big victories she has in her life after residency. She has weekends off and time to be with her boyfriend and her dog. She tells me about her quirky colleagues and her amazing patients. She tells me how different things will be in a few short months.

So, on Little Zo’s third birthday, I went from zero (dragging myself out of bed after an exhausting month on inpatient service during asthma season), to 60 (sobbing in the Starbucks parking lot), to somewhere in the middle. I am thankful for three years of motherhood. Thankful that Zo is vibrant, healthy, active, super-smart, and super-sweet (when he’s not biting or hitting). Thankful for only 3 more days on inpatient service before 2 months of elective and that I've been able to do great work this month and keep folks' babies alive and healthy! Thankful for friends like KJ who understand the struggles of residency-based medical practice. Sad that I wasn’t at home snuggling Zo and our visiting family members. And hopeful of life after residency.

Happy birthday to my little roaring dinosaur - Mommy loves you!

Wednesday, July 23, 2014

Say What?!? Time to find a job!

It’s that time of the year. Career preparation time. I am applying for community pediatric jobs in the D-M-V (Washington DC-Virginia-Maryland) area and it feels surreal. Medical school in the area was extremely enjoyable and our family hopes to return and lay some roots (is it weird to really want to be on House Hunters?!?).

What didn’t happen:
- I didn’t get Chief Resident. I was pretty bummed out for several weeks, but I think it’s for the best. My mentors reminded me that I pretty much have all of the skills I would have been able to obtain (leadership, administrative) and if I am totally honest with myself acting as an Inpatient Attending for several weeks and crazy hours is not my cup-of-tea! I’m all about outpatient medicine and am ready to have regular hours, my own patients, and more time with my family. No pseudo-residency-with- poor pay increase for me.

What has happened:
- started talking to my Academic Advisors about my interests in community pediatrics
- had a few outstanding people offer to serve as references (Clinic Director, Chair of our Peds Heme-Onc Department, Mentor, etc . . .)
- written and revised my cover letter
- written and revised my Curriculum Vitae (CV)
- gotten considerable feedback from my Clinic Director, Academic Advisor, family and friends including an amazing sorority sister who's a Lawyer who cut my cover letter up so much that I basically rewrote it and it's soo much better
- started regularly visiting the PracticeLink and Pedsjobs websites
- registered for the AAP National Conference in San Diego in October

What I still have to do:
- finish reading “Lean In” (loving this book, so enlightening and inspiring. I’m all about leaning in!)
- send out my cover letter and CV to personal contacts in the area letting them know I’m ready to “discuss employment opportunities” (loving the sound of that)
- actually find some jobs to apply to
- go to the AAP Conference’s career fair and professional development sessions and dazzle some program/practice reps and learn about interviewing and contracts
- finish the last 11 months of residency
- start work as a Pediatric Attending Physician (woo-hoo!)

Alright practicing physicians - any suggestions? Anything you see missing in my list above? In applying for jobs after Residency what mistakes did you make? What do you wish you’d done differently?

Thursday, July 3, 2014

Play dates: Mothers in Medicine Style

Most of the Mothers in Medicine contributors, including myself, write anonymously. I write about my husband O and my son Zo knowing that folks who know me can figure out pretty quickly who I am. I write as if my boss is reading my posts, though I have never actually told her, but just in case, I write as if she may read them, nothing too embarrassing. I write to share and get feedback from folks near and far who understand my struggles and my triumphs in ways that my non-physician family never truly will. I have been writing for MiM since I was a Medical Student and over the years I have started telling folks beyond my family to check out my posts including some trusted work colleagues.

Over the years, I have felt like I have come to personally know many of our regular contributors and even a few of our regular commenters. I hope that someday there will be a big Mothers in Medicine Conference or maybe just a gathering at a bigger annual professional conference. When I read Cutter’s posts I said, hmmmm, I think we work in the same hospital! Flash forward to several months later (and many thanks to KC) and Cutter and I had our first MiM meet up at a local museum. Her daughter is super duper cute and Zo was smitten at first glance. He quickly followed her to the slide and then he began chasing her around the exhibits.

Play dates are always good times to reflect on the joys and vent about the struggles of motherhood, but when the other parent is a MiM, it is especially cathartic. Cutter is amazing. Chief Resident, Super Mom/Wife, super hair braider (from Youtube videos nonetheless). We spent hours talking and it was so nice to have someone who understands the doctoring and the mothering because it makes for a really unique life.

I have had a few other play dates with women Doctors including several with a beloved Attending who has young children. These times are equally amazing. She has the wisdom of being several years out of residency and fellowship. The first time I asked her and her kids out for a play date, she gladly accepted. We met up at another local museum and the next time at a park. Each time there was a lot of her being a cheerleader, saying “You’ll get through this.”

Play dates with stay-at-home mothers usually involve looks of pity and many exclamations of “I can’t believe you work that much.” Play dates with 9 to 5 working non-physician mothers usually involve less pity, but still many “I can’t believe you work that much” looks. There was none of that at our MiM playdate and I liked it!



Here’s to many future play dates, MiM style!

Monday, May 12, 2014

Hot (Scheduling) Mess

There has been a lot written lately about work-life balance. In a session with my Therapist last week, she laughed and said “you’re a Resident, for this last year of residency, I really just want you to survive!” We spent the remainder of our session coming up with ways that I can pay people to do things I don’t have the time to do. And she made me promise to work harder to eat better, sleep more, and exercise more; my turn to laugh. Next week, our family will be trying out a week of made-from-scratch meals from a local organic market while I finish a busy week of nights. And we are looking for a second cleaning person after the first one proved to be a bad fit with our family.

Scheduling time away from work for things like research, board exams, and doctors appointments is an exceedingly stressful aspect of my life. Because we get our schedules pretty late, I try my best to email the our Scheduling Attending and Chiefs at least several months before I think I’ll need time off. Nevertheless, I sometimes get my schedule and there are conflicts and then I have to forward back my original email requesting time off and the hot-scheduling-mess begins.

Last year, when I took my Step 3, I emailed the Scheduling Attending and waited so long for a response that the dates kept filling up. I had to extend my eligibility period and finally had to use research time to take the test. I have heard countless stories from other Residents recounting their shared experiences (many have to use vacation time) and how stressful it is to try to do things you have to do.

This year, my son will be spending my last Intensive Care Unit month with his grandparents while my husband is away doing research. He will spend the first 3 weeks with my parents, but once their vacation time is used up, he’ll spend an additional week with my in-laws. At the suggestion of my husband, I emailed the scheduling Attending and requested off a single day and offered to make it up during my vacation.

I feel guilty that we need our parents to watch him. I feel guilty that I asked for a schedule change. However, it would have been a very stressful and traumatizing experience for all of us if I tried to travel, get Zo acclimated, and get myself ready for life without my family for a whole month in 2 days. And then to make me feel even worse, I get an email saying that the Scheduling Attending talked to my Residency Director and my Clinic Attending and she would like to know if I really need that extra day off. They understand my unique situation but they want to double-check before they reschedule me.

As I began to stifle my tears, my husband came over to rub my back. I explained my distress and he reiterated that even though it’s hard, I have to ask for what I need. He reminded me to not feel bad and that “it’s the culture” of medicine that makes it difficult for folks to realize that what we are asking for is not unheard of.

After taking a break, I responded that yes I do need the day, that I would personally call the 2 patients I have scheduled, and that I again would be more than willing to make it up using a vacation day.

Thus ends this installment of my hot-scheduling-mess until the response email. Dunnn dunnn dunnnnnnnnnnn.

Monday, April 7, 2014

Homeschooling options for the busy parent

My husband and I are products of public school education. Don’t get me wrong, we are both extremely motivated and successful but we both believe that our education was lacking in very significant ways. My husband now teaches college students who have only been taught under “No Child Left Behind” and we are both very concerned about the results of this method of learning. As the parents of an extremely bright and energetic 2.5 year old, many of our conversations revolve around preparing him for a future that requires tools that traditional education will not provide him with.

One of my best friends from college who is an innovative teacher and curriculum developer attended Montessori schools for her early education. The methods she used to remain organized during college amazed me. She color-coded and charted and organized in ways that I did not even know existed. Studying for me was always about picking up my book, reading, taking notes in the margins, and more reading. It wasn’t until medical school that I learned how I most effectively studied. I began drawing funny caricatures (nothing close to Netter’s) and charting and mapping things out so that I could better process the material and retain it later. As a second year Resident I still use this method. I can’t even imagine how much stress could have been relieved and how much better I could have learned if I studied better earlier.

Back to Zo, my little genius in the making. He amazes us. He is more than a sponge. Every day he comes home and does and says something new; something that makes us pause, smile, and say "how/when did he learn that?!?" My husband and I are exposing him to as many good things as we can. We listen to music (kiddie things like the Dino V, adult things like soul, jazz, rap, classical) and dance all of the time. He helps us cook (he mixes), plays outside, goes to museums. He attends an amazing Spanish-immersion daycare and knows more Spanish than both of us. We got rid of our TV when he was an infant, though he does watch a few hours of Netflix Dinosaur Train and Turtle Tales on the weekends while we straighten up and prepare breakfast. Every 2 weeks we get a new book kit from the library that contains 15 books on a toddler-friendly subject.

But he’s learning so fast and I know he can learn more, I just don’t know how. I read Amy Chua’s Tiger Mom and I’m not a fan of her parenting philosophy, but I will incorporate some of the things that I agree with and like. I want Zo to learn the best way he can, I want him to learn a martial art, to be fluent in another language (Spanish), and play an instrument (kind of got this from Chua and Fifty Shades of Grey, LOL!). I belonged to an amazing mommy-group in the mid-Atlantic before starting residency where many mothers home-schooled and their children were so inquisitive and learned; it was inspiring. I love being a doctor and homeschooling full-time is just not an option for us. 

I have begun researching “homeschooling” options for working parents and am looking for more resources. If you have done modified homeschooling or know anyone who does, please send them my way. I promise to keep you all updated on our progress. Things will be kept very simple since we only have a toddler, but I’m sure as he ages, I will find other fun, innovative ways to supplement what he learns at school. 

So for this week’s "Homeschooling for the Busy Parent" activity:

- lots of fun time and play, dancing, riding our bikes outside, and time at the playground
- nightly reading of our colors books
- I will make some simple flash cards and we will focus on primary colors and then secondary colors using a concept called “isolation” that I learned on YouTube from a video-blog called “Preschool Homeschool”

Monday, March 31, 2014

Keeping it moving on an overnight call

5 admissions, 4 discharges, PICU transfer. That sums up my night.

I could dwell on the negatives (exhaustion, cold under-heated hallways with headache-inducing fluorescent lights) or I can focus on the positives.

The positives. We managed the craziness with style and grace. No one died. Though one Nurse did come down with something and ended up in the Emergency Department. We (Interns and I) learned many things about patient care and prioritizing. I learned that even though my eyes are burning and my reaction time has slowed down considerably, I know enough to keep patients alive, manage a variety of conditions pretty darn well, and even alleviate some parental anxiety. I can successfully perform a lumbar puncture even after the Intern is unsuccessful and I have to bust through the big ole’ hematoma he left behind. Bammm how do you like all those red blood cells?!? What lab representative, red blood cells aren’t good?!? Of course I know that but at least I have enough cerebrospinal fluid for a gram stain and culture. Could you run those STAT please?!? I can scrounge up a makeshift meal (cereal, graham crackers, peanut butter, diet Coca Cola) to avoid my own hypoglycemia in spite of the fact that due to budget-cuts the cafeteria now closes at 8pm. I can snuggle sick babies and help position them so that they don’t become hypoxemic at 2:30am. I can make my exhausted Intern laugh at our horrible night. I can make my Nurses feel appreciated and not hate me even though they are ready to label me a “Black Cloud”.

And just to cap the whole night off, after a particularly crazy admission where we were all unknowingly exposed to some infectious respiratory goobers, we exited the room quickly, donned our masks and proceeded to do a modified line-dance down the hallway back into the room where we provided judgement-free exemplary service.

At this point, I just want to curl up in the call room, but there are far too many labs to follow up on and kiddos to check up on.

So to those out there in call-land, keep it moving and keep those patients alive! Cuz’ you know I will :-)

Monday, March 3, 2014

My Big ‘ole Fierce Mama Heart

Somewhere between first seeing the 2 purple lines on my pregnancy test and wrestling with my 2.5 year old toddler as he runs giggling at full speed and throws himself into my arms, I have gained a big ‘ole fierce mama heart. It’s strong. It’s wise (wait, did I say that, ME, wise?!?). It’s powerful. It feels more strongly than anything I ever could have imagined.

It has changed me. Immensely. I know that I am so much more of a better clinician because of it. It keeps me up when I’m on call. It makes me teach the Interns and Medical Students more about how to care for our patients with all that we have. It makes me spend extra time reading and enhancing my knowledge base. It helps me give practical advice to my clinic patients and even though some families still can’t believe I’m old enough to be a doctor, they seem more comforted when I talk to them about my own family.

I’m different because of this shining little boisterous boy who chose me to be his Mama. The one who drools on me as I laugh. The one who says “Mama go to work” and walks me to the door in the morning. I leave each day with him blowing me a kiss after I ask “dame un besito”. He has given me this big ‘ole fierce mama heart that I am soo thankful for.

Monday, February 24, 2014

Stop scaring the "fresh meat"

I volunteered recently at a meeting for Latino high school, college, and medical students as a member of my hospital’s Residency Diversity Initiative. I had gotten the announcement a few months prior and realized I would be on a pretty straight-forward month with weekends off. I checked with the hubby that I could take about 3 hours during his prime studying time to volunteer and he agreed.

The students were engaging. The high school students asked silly yet endearing questions. One absentmindedly asked another resident and myself our specialties three different times because he kept forgetting what we said. He was sweet, but goodness, I hope his focus and attention span increase before starting college.

Several of the medical students asked very educated questions, ones that showed they knew where they were going. One particularly prepared medical student, dressed smartly in an off white blouse, flattering pencil skirt, and pearl necklace asked a series of questions that we answered. She thanked us and left. Then she came back later to chat some more. She began her new string of questions with “I don’t mean to sound, ummmm, superficial or anything, but even though I’m interested in all types of medicine, I am worried that if I go into Family Medicine instead of Internal Medicine that I won’t be able to pay off my loans.” I shared a quick, knowing smile with the Family Medicine resident sitting next to me and we began to talk to her about following ones passion. We also reminded her several times, indirectly and directly that regardless of what type of medicine you practice, each of us will be in the top 1% of US income-makers. The top 1%.

Yes I know $120,000 instead of $200,000 (in a surgical subspecialty) seems like a huge deal, but honestly, every single Family Medicine Attending the other resident knew and every single Pediatric Attending I know is living very well. Yes, they may have a ton of debt they are working to pay back, but every single one has a family that is well taken care of. Everyone I know has a nice house (mostly owned and not rented), a decent if not really really nice car. And none appears outwardly to be struggling to afford their basic needs. I apologize if these are material things, but that’s what she was asking about and we answered because it’s a very real concern.

And that’s the Attendings, not the Residents. Every Resident I know, including myself, lives in a nice apartment. Many Residents in my program own houses, not rinkey-dink jacked up houses, but really nice grown-up houses with nice yards. We can afford to go on vacations and we buy what we want at the grocery store including at Whole Foods (which my father-in-law refers to as Whole Check). My husband and I budget our limited money well and hope to buy a house in the first several years out of residency. And we are already well on our way to having my student loans paid off within 10 years using the income based repayment straight out of medical school. Don’t get me wrong, if we didn’t have my husband’s graduate school scholarships, our family of 3 with a single working adult (me), we would be very close to being eligible for public benefits (Section 8 housing, food stamps, WIC, you name it); some of our neighbors are on assistance now.

So, seriously, I know many of us including myself are in debt. And I know we need to do things to overhaul “the system” so that serving patients and saving lives is compensated in a common sense and equitable way. One that values innovative, smart approaches such as preventative care and comprehensive services. One that doesn’t cause very capable and compassionate students who are interested in our field to go running the other way as they eye the ever-mounting price tag. But even at the lowest-paying end of the spectrum, we all will make more money than the majority of our country. And if we help each other to become more business-savvy, we should never have to struggle to live well.

The medical student left smiling. I left more inspired. Hopefully we encouraged her to pursue what will ultimately make her the happiest so that she can bring her “best self” to work every day; she owes it to herself and to her patients. Yes, it’s a daunting task and the realities of practicing medicine in our country are scaring the crap out of many of us and our future colleagues, but again, we are still positioned in one of the best fields that exists. I am committed to reminding myself, my colleagues, and the “fresh meat” that this is the reality we find ourselves in. A bit daunting, but not too scary.

Wednesday, February 5, 2014

Involved, but not quite a “Lunch Lady”

Today was my first day volunteering at Zo’s daycare. He attends a quaint Spanish-immersion daycare and we love it! My husband and I can’t say enough about the amazing ladies who run the daycare. The children are loved and now Zo knows more Spanish than both of his parents.

I grew up with a stay-at-home mother who volunteered at my school all of the time. Much to my chagrin, for a short while in elementary school she was a “Lunch Lady”. I never really realized just how much it shaped me to have my mother around so much. I may have complained in the moment, but knowing that she was around gave me a sense of stability that has truly shaped who I am.

Flash forward to today, as I sit during a “stay-cation” (not nearly as much fun as Cutter’s "Best Week Ever"), I am working on IRB revisions, completing training modules, a case report, and ordering interview dinner food, all while getting over a fierce upper respiratory infection. In the midst of the many moving parts in my life, I volunteered at Zo’s school today and it was SOO MUCH FUN, here’s how it went:

When I arrived at the agreed-upon 10am, Zo’s eyes lit up and he proudly told every toddler who tried to hug me “this MY mommy”. His teachers began singing a song in Spanish about cleaning up and getting into a circle and 85% of the children obliged. I then pulled out Zo’s favorite dinosaur pop up book “Dino Roar”. The kids, and especially Zo, loved it and we all growled and pointed at interesting pictures. At around 10:35am their amazing music teacher Miss K came in for their weekly music class! She led the toddlers in activities involving drums and little shakers. We danced and clapped our hands and she even reviewed some music composition with them. When she left, I read another of Zo’s favorite books about loving others called “One Love”. When it was time to leave as they prepared for lunch and nap time, Zo cried and I almost shed a tear.

I truly felt like the involved mother I some day hope to be. In a busy day, I incorporated Zo-time, me-time, professional time, and later in the day family dinner time. Far from my mother’s lunch lady days, I hope to maximize my available time and be present in my children’s away-from-home lives as much as possible. It truly was food for my soul.

Monday, December 16, 2013

Healthy, nutritious, and delicious to a 2 year old?!?

It is pretty darn hard making food that is healthy and nutritious when you are working 80 hours a week in the Neonatal Intensive Care Unit (NICU) or 50 hours plus commuting in clinic. Add to that the eating preferences of a 2 year old and you have very stressful situations at least several times a week.

Before, I get into what has worked for us, I raise a question to my fellow MiMs and readers: what has worked for you? Please share recipes, links, prayers, spells, themes or anything else you have found useful. 
 
With the ever rising obesity and dental caries epidemics, O and I are always trying to provide Zo with healthy options. When I have patients in clinic with body mass indexes (BMIs) consistently over the 70th percentiles and disturbing rates of weight gain, and the parents report the child’s favorite foods as “pizza and chicken nuggets,” I cringe. I know it’s hard to get your kid to eat what they need, but it’s worth it, their lives depend on it. And as a doctor, and especially as a Pediatrician, I make it my job to practice what I preach.

Here are a few of our favorites here at the Beehive:
- we prepare what we want to eat (tuna salad, stir fry, slow cooker beans and rice, chicken noodle soup, etc) and then we chop it up, add a bit of cheese, pan fry it on a tortilla and make a toddler-friendly quesadilla that Zo can dip into his favorite Trader-Joe’s garlic-chipotle salsa
- breakfast: greek yogurt with raisins and honey, oatmeal with raisins and molasses, handfuls of raisins (theme = Zo loves raisins)
- lunch: turkey sandwiches with baby spinach, hummus with crackers and grapes
- anytime: hummus by the spoonfuls, oatmeal, Greek yogurt
- when all else fails: his favorite smoothies (said by Zo as a “I want smoo-deeeeee”) option 1 with ripened frozen bananas, a few apple/pear slices, a heaping handful of spinach, milk/ice, and a drizzle of honey or option 2 with ripened frozen bananas, 2 heaping tablespoons of organic peanut butter, milk/ice, ½ cup of raw old-fashioned oatmeal, ½ teaspoon of cinnamon, a splash of vanilla

Hope you enjoy some of our favorites and I look forward to hearing what works for you.

Monday, October 14, 2013

Beauty in Crisis: the dance of the Pediatric Pharmacist

G is a beloved Pediatric Pharmacist in our hospital. She is thorough yet collegial, encyclopedic yet approachable.

Tonight during a crisis I realized yet again why she is invaluable. I am in the last weeks of my first Pediatric Intensive Care Unit (PICU) rotation. Tonight, like other nights, a very sick patient became critically ill. She needed infusions and doses of medications out of the normal ranges and she needed them fast.

I power-walked to the pharmacy to pick up some meds and I got to watch G in action. Together we researched doses and administration. And then I got to sit back and watch the master at her work. She floated. She glided. All the while silently mouthing things to herself like a dancer reviewing her choreography. She taught me her choreography, explaining why she was drawing up the medication in this way, why she was adding it to a carrier fluid in that way. The entire time I was enraptured. It made the physically and emotionally draining night more manageable and allowed me to step back and see the beauty in this crisis. I saw how the members of the team, including me, worked together to bring a patient on the brink of death back to life.

Monday, October 7, 2013

PICU and the Biting Beast

I don’t know when it began, but somewhere in between finishing first year of residency and starting in the Pediatric Intensive Care Unit (uggghhh, acckkkk, poooo), my cute talking toddler became a biting, hitting, aggressive little beast. Sometimes he’s soo sweet and soo cute and I forget that at any moment, when we run out grapes or he can’t find his motorcycle, things could get very ugly, very fast.

When it’s ugly, he hits, he bites, he smacks. Who? Me, my husband, his favorite friends, his not-so-favorite classmates, his bath toys, his Froggy. Oh yes and when we recently tried to redirect him by holding his hand when he swats at us, he even tried a head butt. My husband and I sat stunned, where does he learn these things?

And did I mention I’m in the PICU?!? It makes everything worse. The guilt I feel about his aggressive behavior is exacerbated by my sheer emotional and physical exhaustion. I arrive home sometime during twilight outdoor playtime only to take him away from his beloved friends and the sandbox. I then clean him up and prepare him for bed while he wails and hits. Daddy pours the wine, puts his headphones on, and begins his nighttime graduate-student-writing routine. The only respite I get is story time, where Zo picks out his favorite books and says, “Sit down Mommy” and pats the couch beside him. Then I rock him to sleep as he cuddles and rubs my ears. After that I sit mindlessly perusing the internet for the countless hours while my husband repeatedly says, “Don’t you need to go to bed, don’t you have to get up at 4:30am?”

I have begun polling friends and have gotten: smack him, give him time outs, redirect him, it’s a developmental milestone, this too shall pass. Knowing that this phase is developmentally “normal” means nothing when I pick him up from daycare for the first time in weeks and his teacher says, “Sorry Miss, but Zo bit a friend, again” as she points to the cherubic chunky boy Zo has taken to like an apocalyptic zombie.

I can now proudly say that PICU is over and I learned a lot. I can also proudly say that Zo has made it 3 days in a row without biting anyone besides his toys, we celebrated at school today with dancing and he seemed very proud of himself. He starts everyday with a new family mantra “No biting people!” It’s the little-big victories; we have at least temporarily slewed the PICU and the Biting Beast.