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

Wednesday, November 16, 2016

You don't need me to go pee and other 4am thoughts

I am at a crossroads with my 5 year old. It’s 4 o’clock in the morning and I have just been woken up from some amazing sleep for the countless time with a scream of “mom, I have to go to the bathroom”. I grumpily yell back “go by yourself” and my husband mumbles “that’s not nice!” and said 5 year old yells at me from the bathroom. I get up and our little tyrant is perched on the toilet going to the bathroom by himself. The bathroom is lightly illuminated with a night light. He pees as I gently say “please stop waking mommy up. I’m very tired and it makes me cranky when you wake me up.” “Cranky?” he says. “Yes, cranky because I’m tired” I say. I tell him he’s a big boy and can go pee by himself. He says “okay” then walks to his room leaving the door cracked. I tell him it’s okay to leave his door cracked and he says “okay”. I lay down in bed, he says “please close the door” I don’t respond, hubby gets up and closes the door. I lay awake in bed recounting all of the things that I am doing wrong with him, the things I am worried about with professional drama, good things that are going on (woo hoo congratulations on the new professional leadership program acceptance!), but sleep eludes me and I am so tired. 

This and worse accounts (one particular evening I had a screaming match with him because I wouldn’t come back and put his covers on him just right) document our nighttime ritual. He sleeps completely through the night less than once a week. He pees on himself at least once a month. Me remaining awake for several hours after being woken up is much more common than me going peacefully back to sleep. My husband is usually not woken up, but when he is he rarely has a problem going back to sleep. 

And I am at a sleeping crossroads. Being woken up for months and months and years and years makes for an unhappy mommy and I can feel the effects of my sleep deprivation. I am cranky when he wakes me up and if the sleep is really good I am downright angry. I know he needs sleep, he goes to bed at 7:30pm and wakes up between 7 and 7:30am. If he goes to sleep after 8pm for more than a few days, things don’t go well for anyone. I on the other hand know I need more sleep, but getting in bed before 9pm is rarely an option, but if I could just sleep uninterrupted it would be so much more restful. Tonight though I was in bed watching TV by 8:30pm. 

I don’t know what to do. It’s 4:10am. My shoulders hurt, it’s cold (autumn in the mid-Atlantic in our 1938-built home mean it’s chilly literally all of the time). I want to be asleep, but I can’t go back to sleep. So here I type after sending my husband a “I can’t do this anymore” email that I’m sure will make for great breakfast conversation and texts back and forth all day. 

I know I have options, but in my 4am research I can find very little about nighttime awakenings. Lots about 5 year olds being scared of the bathroom in general, but nothing specifically about what to do when he wakes you up at night and won't go back to sleep. Should I start sleep training again; this time using the same techniques of slowly responding less to his demands each night (but it takes so long!)? Light his room up with an additional night light to illuminate the dark corners? Make my husband do it alone? Refuse to get up with the tyrant anymore? Ship him in a box to my parents? Put a small potty seat in his room as my girlfriend, also a Pediatrician recommends (this seems so gross to me though and all I can think of is tripping on it and pee flying everywhere)? 

Please help! I’m so over this. It’s now 4:25am and I’m going to see if I’m tired enough to fall back asleep.

Wednesday, September 14, 2016

Goodbye hormonal birth control

It’s kind of hard to say goodbye to hormonal birth control when it’s been so good to you for so long. I started taking the pill as a teenager. My father is a teen parent and my mother instilled in me such a huge fear of early pregnancy that I stayed prepared, mostly to avoid her wrath! Talk about the teen brain in action; birth control was a very concrete option. Avoid pregnancy or be beaten, possibly at school in front of all of your classmates. YouTube videos of parents beating teens wasn’t around then, but if it had been, I’m sure this nightmare would have included my Aunt videotaping and putting it on the Internet. (note: I am totally over-dramatizing this and my mother and Aunt are two of my dearest friends now. They loved me fiercely and kept me from all types of danger including a few college boyfriends who were up to no good.)

I still remember sneaking to Planned Parenthood (it was across the street from a busy metro station) in order to get my first pack of pills. I was sweating, I was scared. But larger than my fear of being seen was my fear of getting pregnant and having to tell my parents. I knew getting pregnant before college would make my dreams of becoming a doctor even more of difficult to achieve, if not impossible. I had my share of providers over the years. I remember one male doctor that tried to shame me by drawing horribly graphic pictures; I wanted to yell at him but was too scared. I remember some outstanding older nurse providers (one super cute grey-haired lady in particular) who were very sex-positive and helped me try various methods.

Methods I have tried to date (in semi-order): combined oral contraceptive pill for years, the patch for less than a month,  Depo-provera for a few months, abstinence, emergency contraception, pills again, the ring for a few cycles, the Mirena IUD for 3 years, a healthy planned pregnancy 3 weeks after discontinuing the IUD, breastfeeding and the mini progesterone-only pill for a few years, and finally my second IUD.

Somewhere around age 30 and my pregnancy, I began to have hormonal headaches each month around ovulation and changes in birth control. Now that Zo is well out of diapers, we are ready for baby number 2. So I said goodbye to my second IUD. Hubby and I decided this would be the end of hormonal birth control for us until we decide to have someone’s tubes tied. I am still holding out hope he’ll see me waddling around pregnant and will decide to get a vasectomy.

I know this country tends to shame sexually active teens, but I was one of them, and I turned out alright in my opinion. I’m a pretty successful Pediatrician, married, with a child. I have friends who used various methods and ended up teen parents and now as an adult I have countless friends dealing with infertility. I wasn’t promiscuous (though I won’t shame those who are), but I always knew that avoiding pregnancy and infection were top priorities for me (referring back to my mother who wanted no parts of being a young grandmother). Now that infection is virtually impossible (if anything goes down hubby will have some ‘splaining to do) and we actually want to expand our family, I say goodbye to my old friend hormonal birth control. Thank you for keeping me safe and allowing me to follow my dreams.

Wednesday, August 17, 2016

The things we do to succeed

I didn’t want to do it again, but here I go retaking my Pediatric Boards. I can list all of the reasons why I was unsuccessful at my first attempt: I was working too much (50-60 hours per week, getting paid to work 32), I was too stressed (issues with my former boss that I can’t discuss), I wasn’t sleeping enough, I have testing issues but my boss told me she couldn’t adjust my schedule so that I could study more. So here I am hundreds of miles away from home spending close to $2000 to take a 6-day intensive board preparation course. I am doing all that I can to succeed this time. And I refuse to allow the posttraumatic stress of retaking this test overshadow all that I am doing to succeed.


I have met so many outstanding doctors, most of them mothers, who have their own stories of failing their general boards or their specialty boards. These women are some of the best doctors I have ever met and provide exemplary care but they each failed the exam the first time. The stories read just like mine: working too much, stressed, not sleeping enough, family obligations, poor work-life balance. Some have a history of failing other board exams (USMLE or their specialty boards) but others don’t. Why does the cycle repeat? Why don’t we shake our little doctor sisters and say “wake up girl! There is no way you can balance all of this! Cut something back. Cut something out. Or else!”. “You can’t go on like this!”. “You either sacrifice now and focus primarily on passing or you’ll be forced to retake the test after failing!”. “Girl! Don’t do what I did. Let me tell you how I didn’t rock this test!!!!”. Or “Friend! Let me help you pass this test!”.

That’s how I want to recreate my narrative. I’m going to pass this test even if it’s by the skin of my teeth and then I’m going to mentor little sister docs so that they don’t make the same mistakes I did in post-residency auto-pilot mode thinking “well 60 hours is so much less than my resident’s 80 hour work week”. Let me tell you something - it’s not better after all of the years of sacrifice and don’t even pretend like you are not exhausted and burned out. And trying to work that much on top of passing this exam if you have even a hint of testing challenges is a major no-no.

So yeah, please Mothers in Medicine, send me some good vibes because I’m away from my family in this cold hotel room wrapped in blankets giving my all in order to succeed.

SIDE NOTE: In other random news, I just learned that the Peds Boards may become an open book test in 2017. Mwomp mwomp mwomp for me! If I could sit this round out, I would, but my new position depends on me passing this year. I hope the open book re-certification exam doesn’t cost more. Alright, I’m going to block all of that out and keep my nose to the grindstone.

EDIT: I removed the part about the salaries of the American Board of Peds folks because I cannot figure out how to fact-check it so it could be very untrue.

Wednesday, July 13, 2016

All of the ways I forget

I had my 90-day evaluation in my new position today. I left the clinic I was working in, one overrun by burnout and toxic management, in order to remember why I went into medicine at all. I love my patients and this work, but I love my family more. I now work 3 days a week in health care administration and quality improvement. I sleep well at night now that the main cause of my insomnia has ended. My family is happier. My evaluation went very well.

Immediately after my meeting, my husband reached out and said he needed to talk. I needed to talk too. He is finishing his dissertation this week, we just bought a new house, and my parents came in town for the weekend. We have been passing like ships in the night. Both busy and not really checking in enough. With moments of hugs and kisses and simple appreciation. But overall, we haven’t been checking in frequently enough and we definitely haven’t been having the weekly meetings that are my bookends at work.

I feel lonely. He feels unappreciated. Why didn’t I offer to help with his appendices? Why didn’t I read the chapter he asked me to read so many months ago (honestly, he gave it to me and I forget and he never mentioned it again until today and now I feel like dirt). He feels that my work has taken priority in our family for years (medical school, residency, the toxic job took so much of our family’s energy just to stay afloat). And now I’m studying for my Boards again after I failed them last year (more about that later, I have a lot to say about it but it's so raw and traumatizing). And he’s finishing his dissertation and starting his first job as a professor at the state university.

When we get busy I forget that my marriage needs check-ins, scheduled ones, on purpose because they are priorities. And when we are busy, we both have to go the extra mile to make sure that my needs, his needs, and our family’s needs are met.

And I’m sitting here at work, dragging my feet because at home I am reminded of all the ways I forget. I need to go home and start remembering again. And I need to be gentle with myself because we are juggling plates and though many of them are scuffed up I pray that none of them are smashed and destroyed. I’m going to head home now in order to remember that I love him immensely. And loves me. And we can't forget.

Wednesday, May 25, 2016

Don't forget they are someone's baby

Living in DC and taking the metro regularly provides me with ample fodder for social analysis and ample opportunities to be upset and amazed by humanity. For example, I get upset when able-bodied people see disabled, elderly, or pregnant people standing and sit in their seats anyway. Especially while pregnant, I spoke up very loudly (ex. As able-bodied men crowded on an elevator as I waddled to catch the door for a man in a wheelchair. I stared everyone down and said someone needs to get off so he can get on; we were obliged begrudgingly.). I am amazed when folks step in and help someone in need during an emergency.


An issue of growing contention in my neck of the woods is middle and high school students getting onto crowded trains. They are loud and there is often cursing involved. However, I have noticed that most of the adults regard them in a very unfriendly way or simply ignore them. The local listservs I am a member of are far worse; the disdain for these children is palpable and I have had to step in several times when the racism and classism became unbearable as well-to-do grown folks called children thugs, crooks, and goons. It literally hurts my heart!


I personally make it a point to acknowledge these teenagers every chance I get with a smile or a hello; sometimes I’m ignored or begrudgingly acknowledged, but oftentimes you can tell these young people relish the positive attention and are surprised to have been seen. I remind myself regularly that they are someone’s baby no matter how “hard” they are appearing to be. No matter how many tattoos they may have on their young skin. No matter how many curse words they and their friends yell. And I try to remember that someday my little Zo will be one of these students taking the train and I hope that others will treat him well knowing that he too is someone’s baby. My husband and I are well-read in the studies that show that Black boys like my Zo are seen as being older than they are by the majority and less innocent than they are by police (see FURTHER READING below). We know the sickening statistics of disproportionate violence against boys that look like him. We pray that folks will remember these children are someone’s baby and that he is ours.


To bring it back home to the DC metro, the other day on the train a handsome young man with beautifully styled locs and sagging skinny-jeans and a uniform high school shirt  entered the train with a young woman I assume was his girlfriend. His new-aged rap music (the kind old hip-hop heads like me can’t understand and abhor due to the crazy amounts of auto-tune) was blasting. Adults bristled. Some sucked their teeth. He walked on the train and I smiled at him, he was visibly surprised, smiled back sweetly and sat directly behind me. Every other word of his song was f--- this and blast that. I turned and said as gently and respectfully as I could “Sweetheart, don’t you have headphones or something? My old ears just cannot take all of that cursing.” He said quickly “Ohhhhh my bad! My headphones broke and I don’t have another pair, My bad!!!” I pulled out a set of headphones from my bag and said “here, you can have these!” He smiled and said “For real?!? You serious?!? Thank you so much!” And just like that - connection. Respect. Compassion. His mama would be happy.


It could have ended differently. Someone else could have started cursing at him. He could have rebuffed my offer and cussed me out. But it ended wonderfully. And I modeled appropriate, compassionate behavior for children and adults alike.


I exited the train at my stop and wished him and his lady a good day and he did so too.
___________________

FURTHER READING:



Monday, April 4, 2016

The DC public school lottery struggle is real!

I will paraphrase my mommy friend C when she said “we literally have spent hundreds of hours on this”.


We moved back to DC June 2015 and since then have spent hours and hours touring and talking about schools. My husband O and I are both products of public education - we know it has many challenges and limitations but we are both committed to having our son Zo in a public school that all children have access to. We were extremely blessed in North Carolina to find our outstanding Spanish-immersion daycare. We never ever ever worried about him while he was there. We hope things will work out with public school, but thankfully being a doctor-mom, private school is a viable option.


WHAT WE ARE WORKING WITH:
Flash forward to public school in DC and we have had issues with lack of supervision in the bathroom for the preschoolers, lack of vision, organization, and communication from the administration, teachers who rely too heavily on strict discipline and quiet, homework for preschoolers, and the disorganized and understaffed aftercare that we promptly pulled him out of. What we have loved about Zo’s school - that he really likes it, the Principal Mr. L (he is truly wonderful, so committed to the students and parents), meeting wonderful families and making new friends, the beautiful playground, being a Parent-Teacher Organization parent (I feel like I’m becoming my mom every time I attend a meeting), and the overwhelming majority of his teachers.


MOVING FORWARD:
In early April we find out the results of this year’s lottery. For those who don’t know about DC public schools - there are public schools and separate public charter schools. Some participate in the common lottery and others have separate application processes. All super confusing and overwhelming unless you live in an awesome neighborhood with in-bound preference which we don’t. We based our rankings on a private session with Educational Consultant EV Downey (I still shake my head writing this cuz’ who thought you’d need to pay someone to figure out where to send your kindergartener but I quickly realized there were way too many schools I didn’t know about and I am all about tapping into my resources so we went ahead and paid her and it was well worth it), hours and hours spent touring schools in our preferred neighborhoods, countless conversations with each other, friends, and school administrators. There are so many different schools. So many different neighborhoods (drop off process and location is of prime importance in DC), school buildings with very diverse architecture, philosophies, discipline plans, and aftercare programs. So many different “vibes”.


A few of my favorites (in alphabetic order):
- Capital City, a well-established charter school with the most perfect natural outdoor space and great reputation. Too far out of our preferred neighborhoods, but if I could it would have been in my top three
- DC Bilingual, a well-established Spanish-immersion charter school. In a really nice building, but they might have to find a new site next year. Ranked low for us as not knowing where the school building will be was a deal-breaker for us.
- Mundo Verde, a Spanish-immersion charter school focused on environmental justice and study of world cultures. We love their vision.
- Two Rivers, we preferred the Young Campus as its closer to our preferred neighborhoods and O really liked the Principal
- Tyler, a public school with a Spanish-immersion and arts program that O loved

- Van Ness, newly renovated and reopened public school in Navy Yard (prettiest public school I’ve ever seen though in need of a new playground; which I hear is in the works)

Monday, March 21, 2016

I'm a grown woman and my work bag needs to represent that

What do you do to celebrate yourself? How do you toot your own horn?

I am a part of several very lively on-line support groups for mothers. I love many of the posts and I have especially started to really enjoy the posts that talk about how busy mothers reward themselves with things like fancy purses, fabulous trips and paying off their loans. I don’t think we do as much as we should to celebrate ourselves, to be gentle with ourselves, to love up on ourselves. After the first 8 months of being an Attending, I sometimes realize that besides going to the gym I haven’t done a single good thing just for myself in a week; that’s when I schedule an eyebrow shaping or pedicure appointment (I am overdue for both by the way, uggh!). I am going to start with the purse, build my way up to a trip next year, and before turning 40 - these loans will be paid off!

Back to the bag - the work bag my mother bought me at the beginning of residency has been through a lot. It’s a nice, large personalized LL Bean bag but it has begun to look weathered and frayed. I’m too young to look sloppy and unkempt and I need an upgrade. I went out with some of my Sorority Sisters recently and I noticed how all of the Lawyers had beautifully sculpted, supple leather bags - they were gorgeous! 

That’s when I decided - I’m upgrading myself as soon as I get my first check from my new position (more on that later). My budget is modest and several friends recommended Coach (my favorite is the Coach Mercer Satchel in eggplant) due to their durability and timelessness and some sister-doctors recommended the Dagne Dover (I like the roomy Charlie Tote the best). And now I’m ready for my own, not-a-hand-me-down, grown lady work bag. One that I’ll feel like singing Beyonce’s “Grown Woman” out loud as I carry it into my new office. 

Any recommendations for your favorite work bag or purse? One that will not be flashy while commuting on the DC metro? One that will allow me to easily go from work to picking up Zo from kindergarten?

Friday, January 1, 2016

Saying their names

I don’t have a television but your story flashes across my Facebook feed, my friends tell me about you, my husband the Anthropologist tells me about you, and I look you up online.


You were bullied for being a cheerleader and you took your life (Ronin Shimizu). You went out for a pack of Skittles, a stranger chased you, you were shot and killed (Trayvon Martin). You were selling cigarettes on the streets of New York and you were choked to death as you screamed “I can’t breathe” (Eric Garner). You were playing with your big brother and he accidentally shot and killed you with a gun you found (9 month old in Missouri whose name will not be released). You were born a girl but your birth body was that of a boy, you tried to be your true self but took your own life after not being accepted by your parents (Leelah Alcorn). You were misunderstood, you were playing with a toy gun in the park and you were killed (Tamir Rice). You were with your friends listening to music in your car at a convenience store when a stranger approached you and began arguing with you about your music, he shot you and you died and he went back to his hotel room, walked his dog, and had dinner and drinks (Jordan Davis).


I honor your legacy with my tears. I think about your family. I snuggle my little one more tightly knowing this world is both a beautiful and dangerous place. I honor you with this post; I apologize it has taken me months to find the courage to say your name in this space. This space that is sacred to me but after my last post about Trayvon Martin received some insensitive comments I was hesitant to share some of my deeper feelings since I don’t see much social commentary here at MiM. Why is that? We are mothers and we are providers and don’t we see how unique our vantage point is? We can talk about the intersection of life and policy, public health and personal life from a place most others cannot. I struggle to find the time to read anything besides mindless fashion blogs when I’m not balancing my own needs with full-time medical practice, my husband’s needs and those of my four year old let alone to allow myself the freedom to reflect on society’s transgressions and tragedies.


I thought of you today while looking at my ever growing to do list. And because your life matters to me I put away other thoughts and wrote your name, I am saying your name.


#BlackLivesMatter #ProudLGBTQAlly #MothersInMedicine #2016LivingMyTruth

Tuesday, December 1, 2015

Life in between my notes

Instead of doing notes this weekend I:

  • made a fall collage with Zo using leaves and clippings from free magazines
  • went on a date night with the hubby during which we ate amazing food and had delicious lavender mojitos and then both almost fell asleep during the movie (don’t go see the new 007: Spectre, it sucked!) and remarked countless times how we wish we had just stayed home and caught up on the Walking Dead
  • caught up on the Walking Dead with the hubby. (spoiler: Glenn no!!! and geeze how does Rick run soo far in those cowboy boots and tight black jeans, I’d have blisters and chaffed thighs!)
  • listened to Oprah and Deepak’s day 6 and 7 morning meditations. It’s beautiful but I don’t quite know how to pronounce the meditations.
  • washed clothes and then folded them with Zo. Who knew 4 year olds were such excellent folders?!?
  • made amazing pumpkin chili (check out http://www.popsugar.com/food/Pumpkin-Chili-Recipe-35890481)
  • am thankful that after finishing this post I’m just going to go to bed and it’s only 10:21pm and I’ll start the note writing again tomorrow morning at 5am. Only 38 to go!

Monday, November 16, 2015

Thankful in this moment

I am thankful for this hour of quiet. My father is in town helping us for 4 weeks while my husband is away doing research. I signed up to take Zo trick or treating but the greater than 50 notes I have to finish from the last 2 weeks are weighing on me and I have vowed to finish them this weekend.

I am thankful for the opportunity to care for my patients and their families. There isn’t a day that goes by that I don’t laugh and smile and sing and dance with my patients and think to myself or say out loud how wonderful they are. From the teenagers affected by gun violence who are working so hard to graduate high school and stay out of trouble to the school aged children who get so excited telling me about their dreams. To the new parents whose babies are growing and thriving. There cannot be another job like this!

And I am thankful that my position has just the right amount of joy coupled with dysfunction to keep me motivated but to also remain committed to finding solutions to enhance the work experience of community pediatricians. I cannot imagine how folks continue with this schedule for years and years. I have been practicing full time for less than 6 months and I seriously need a scribe, personal/house assistant, cleaning person, and driver for our son. Out of discomfort comes great things so I will work hard to building a better future for myself and future providers as well. It has to get better. And I have some ideas on how to make it happen.

I am thankful for being given the opportunity to raise my beautiful, outgoing, silly, passionate 4 year old with my extroverted introvert of a husband. I am thankful that my husband’s schedule is flexible enough to accommodate random days off from school. I am thankful that my new salary allows my husband the ability to pursue his research interests. And I am so freaking thankful that at this time next year he will likely have a full time job with benefits so that I can work on a schedule that gives me more freedom to pursue my research and advocacy interests.

In this moment I am thankful. And that’s all that really matters.

Monday, November 2, 2015

That parent: you know the one who makes the front desk staff have nonepileptic seizures?!?

For those that don’t know - nonepileptic seizures also known as pseudo-seizures are a phenomenon when a person does not have a real seizure, but they just mimic the movements of a seizure. Sometimes it is for secondary gain such as getting out of school and getting attention or sometimes it is a manifestation of underlying psychiatric illness.

Well, this is a post about patients that really stress providers and staff out and cause us all kind of angst.

I will take a moment to perform some serious self-reflection: I love me some difficult patients (yes, “love me some” as my Granny would say), blame it on my mother being a Social Worker, me being an interdisciplinary major who took a ton of medical anthropology and ethics classes, and me being extremely committed to social justice. Add to that the fact that most of the difficult patients come from places where my cousins still live and culturally I just feel connected to the loud, passionate, trash-talking patients. And finally, blame it on the fact that I have read countless accounts of the biases we providers have for folks we relate to and have against those who aren’t like us. I continually find myself being the only person bringing these biases up. I get it, I'm usually the only person of color in the room and to me these are issues I deal with every day and most of the time these biases harm folks that look like me and come from where I come from (see references below).

In spite of the very real and significant way we providers treat patients differently based on how we perceive them (see references below), what to do when a parent crosses the line? When their own mental health disorder gets in the way of their interactions with care providers? What happens when a parent only knows how to speak in a way that is viewed as overly aggressive to my colleagues and other staff but is culturally tolerable to me (loud, hands waving, maybe with a few expletives)? What happens when essentially an entire staff is overwhelmed with these interactions. There has been at least one time when I felt like the only one still advocating for a family but even I began questioning if I was really helping at all? What happens when we collectively have nonepileptic seizures when a parent comes in the door because we know the ish is about to hit the fan? I'm just wondering. What to do about "that parent"? The one we all want to avoid but who we still want to find a way to work with?

References:
1. Association of Race and Ethnicity With Management of Abdominal Pain in the Emergency Department. http://pediatrics.aappublications.org/content/132/4/e851.full
2. Problems and barriers of pain management in the emergency department: Are we ever going to get better? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004630/
3. Unequal treatment. https://iom.nationalacademies.org/Reports/2002/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care.aspx

Thursday, October 29, 2015

Season finale of “As the Residency Turns”

* DISCLAIMER: I meant to post this back in June as I finished residency but it got put aside as I filled out my umpteenth credentialing application. Here it is now. I wrote it 2 days before finishing my last primary care rotation of residency:

After 3 years of residency I have had some amazing interactions with patients. Amazing in the wonderful way the 9 month old whose well child checks you have always performed smiles and babbles when you walk in way and reaches out for you to hold her. Your heart opens wide, the parents are at ease and you think to yourself, “yeah, this is why I do this!” Or amazing in the way things go when a developmental delay I picked up is being addressed by Early Intervention and we can all see how the affected child is flourishing. Or when you talk that sexually active teen into being more assertive in communication with partners and you get her to get a Nexplanon.

Then I have had some intense interactions of the other kind. Intense in the I was so concerned that I called Child Protective Services and now a CPS worker is here with you and you are yelling at me and I am crying and I want to work with you so much but you hate me right now and won’t listen to anything I have to say kind of way. Intense in the way things go when a parent has what appears to be bipolar disorder and splits on providers and one minute says our hospital saved his/her child’s life and the next is cursing about how several of our providers did them wrong.

During the amazing ones, my heart soars, during the intense ones my heart plummets and I often get palpitations. I have been having a few day run of extreme highs and pitiful lows. I have 2 more days in clinic before my last day of residency at the end of June and there are so many loose ends. I realize that clinic is the only part of residency that resembles continuity; we do other rotations for a month at a time and are essentially visitors but in clinic you are like the cousin who comes home regularly for major holidays and family gatherings.  The end is in sight and I feel like I need some closure - so much so that I helped draft a letter to our patients from the graduating seniors updating our patients on where we would be going and now parents come in and say “Dr. Bee - you’re really leaving us?!?”.

There are so many amazing patients who will continue to grow and I will miss their new developments. And I have a few difficult patients who once I’m gone will literally have no one else who wants to work with them. 2 more days. What can and will I do? Why does it feel like such a huge deal? I think I’m scared and sad that things are coming to an end, it’s for the best, right? Why do I feel like a success and a failure all at the same time?

Monday, October 5, 2015

This child and his sensitive skin

It all started out as a little papule on his left buttocks. In the middle of a busy week of relatives visiting and make-up clinic days, what started out as a small papule morphed into something worse. Zo has had exceedingly sensitive skin since he was 1 years old. Hyperkeratotic plaques behind his knees that sprout up in the span of 2 days if he isn’t slathered in a thick mixture of shea butter and petroleum jelly twice a day. Diffusely itchy maculopapular rashes if we miss his nightly dose of cetirizine. That type of sensitive skin.

I thought I had things under control. But I didn’t.

Monday - I see a little papule on his left buttocks. I put on a thin layer of triamcinolone 0.025% on it. Later that night, I see a few more papules. I put him in the bathtub and then put on more triamcinolone and begin our twice a day ritual for exacerbations.

Tuesday - I see more papules. He is itchy. Is that a ring? Nahhh, I’ll just step up the emollients.

Wednesday - I return home and notice him scratching. How was swimming? His response, “it was fun” as he continues to scratch. Bathtime. Is that a 2 centimeter scaling ring-lesion?!? Oh goodness! He’s got tinea!!! I don’t have time to get clotrimazole and I forget to text my hubby what medicine to get from the pharmacy.

Thursday - satellite lesions. After clinic I run to the local CVS and wait in line for 15 minutes to purchase clotrimazole and by the time I arrive home he's asleep. That peaceful sleep where you know not to interrupt them or all hell will break loose so I let him sleep as I fret about his tinea outbreak.

Friday morning - we begin twice a day clotrimazole use.

Weekend - more lesions. Lower back, posterior and anterior thigh. Areas I won't mention for fear of him one day reading this. But seriously who knew tinea could spread so quickly and that toddlers can get jock itch! Major fail!!! Quick consult to my doctor friends with pictures of all of the lesions minus his groin. Definitely tinea. Definitely spreading; it’s all of the summer camp fun and splash park play dates. Primary care friend KJ says just go ahead and suck it up and put him on griseofulvin too, it’s already too out of hand and you'll stop it before it spreads to his scalp.

And just like that, I have written my first prescription for my son. Too ashamed and time-pressed to bring him in to my new clinic for tinea corporis. I knew the liquid wouldn’t go well as he is now 16 kilograms and our last go round with amoxicillin ended in us making daily smoothies. Based on my calculations, he could do one-half of a 500mg tablet daily - and after all of the pill swallowing for kids I observed due to an awesome program one of my co-residents did, I knew what to do.

Tuesday - I took him to the pharmacy to get him excited about his new medicine to help with his itchy parts. He shook the bottle to a nice beat and did a happy dance. We got home and I cut the pill. Hubby says “shouldn’t you crush this, it’s huge.” I say “nawww, we’ve got this.” Equipped with 1 tablespoon of honey and half of the pill, I say, “okay, you’ve got to swallow this without crunching it up.” Zo smiles, says okay and then hubby offers him some extra water and then VOILA!!! My almost four-year-old swallowed his first pill!!! Proud doctor-mommy moment in the midst of a crazy week.

Tuesday, September 1, 2015

What in the world?!?

I was supposed to be much farther along in my studying goals and there are 6 weeks until my pediatric boards and every week I realize how much further off track I am.

I thought my schedule was “made for” studying. Four-day work week with Fridays off. And then my clinic closed for 2 days and I’m making up those days on my off days because I don’t have enough comp time yet.

And then the fancy, super detailed Google calendar study plans that I worked so hard on are being utterly obliterated. The first 2 weeks I was solid, but that was when my patient load was only at 50%. Then when I got up to 75% things got real. And now that I have a full patient load there is literally not enough time in the day to sleep, eat, see patients, work on notes, call patients back, read consult notes, spend at least a few hours with my family, and finish the notes that I didn’t get done earlier in the day.

I hadn’t even realized I had gotten to the 6 week mark until one of my study partners mentioned it. What in the world?!? She said “it’s time to go to PICU hours?” And she’s totally right. Something has to give and I don’t have $2,265 nor the time to retake these Peds boards. My husband is super supportive and tells me to take the time that I need but after so many years of missing out on tons of family related activities it just breaks my heart to be at this coffee shop doing Med Study questions on a beautiful Sunday morning while my family is at the park but hey - it’s going down!!! (well right after I write this pity-party of a blog post)

I’ve got this, right?!? I just remember how grumpy I was during the PICU because of the sleep deprivation. At least I don’t have to calculate TPN (total parenteral nutrition) or ventilator settings.

Alright ladies - I need your support. Your encouragement. What did you do? (I scratched that because I have all of the resources I plan on using and don't really want general info about how you studied cuz' we all study differently and I know me - I'm all about practice questions). How did you do it? How did you balance it? Did you study as much as you'd planned? Did you get up at 5am? When did you do your notes? When did you study?

Monday, August 3, 2015

Every little bit

2 weeks into attendingdom, I am starting to realize how life has changed fundamentally. Gone are the days of working 75 hours a week. Gone are the days of calculating TPN and anion gap. Gone are the days of being questioned about details that you struggle to remember and know you’ll never need again outside of residency. I now work 4 days a week and can pick up a weekend day if I want to. We haven’t had an office emergency that I have managed yet, but I’ve got emergent management for the 15 or so minutes until EMS arrives down. I’ve got that!

In spite of my nice schedule and awesome colleagues, I realize that it will take a while to let go of my resident mindset. During residency, a resident-mommy-friend and I would chat and comment about how guilty we felt missing out on things. Not being able to care for a sick child. Not being able to make it to bedtime. Missing out on weekend fun. And I realize now that although I won’t be able to always take off to care for my sick child, I have more flexibility to. I now can make it to bedtime every day of the week. And other than my one Saturday a month, I’ll be around for the weekend fun.

Last week on my off day (every Friday), I attended Zo’s first summer camp performance and the joy on his face when he saw me cheering in the front row was priceless. It’s taking my breath away now to remember it. I took him home early, we played at the playground and then went home for family dinner time. I am at a coffee shop now writing this post before restarting a timed section of the 2014 Prep pediatric board questions. This week, I got to attend his second performance and it was just as cute. This week I was strong enough to let him stay for a few more hours while I study (last week I just couldn’t - since in the old days I very rarely could pick him up early).

I want to be able to enjoy every little bit. I want to be a present parent. I want to be a present provider. And I am (for the most part, I was kind of late for his performance today, but I just had to do 5 more questions and get that samosa from the local shop)! After so many years of waiting to “get there”, it’s here and it’s mine and I’m committed. Next time they ask who wants to work overtime I think I’ll pass and stay at home to snuggle with my family. Here’s to enjoying the little bits, the fundamental shifts, and this new phase in life. Question 151 here I come.

Tuesday, July 7, 2015

Attending Status: let's go!

I woke up to the sounds of the birds chirping and then “Mommy!” as my almost 4-year old tried to start his day at 6:45am. Quick detour for a potty-break and then promptly back in his bed because, “It’s still too early. Time for sleep.”

As I sit at our desks, I double and triple check that my Epocrates app is up to date so that I can quickly calculate drug doses. Today is my first official day as an Attending. I am returning to my dream health care system to work in the pediatric clinic I did my third year community pediatrics rotations in. The Attendings and many of the front desk staff remember me back when I was a medical student and they, like me, are super happy that I have returned.

We had an all-day orientation yesterday that was truly inspirational - yes, I’ve drunk the Koolaid as they say and am already one of those super happy people to work where I work. Providing care to children in our nation’s capital is truly an honor and one that I do not take lightly.

During times like this I refer back to my favorite book The Alchemist (Paulo Coelho). I was tested immensely in these last few years, but every second of the journey brought me closer to the realization of my dream. Every struggle. Every triumph. And I’m here. In this moment. Feeling the immensity of years of pre-medical studies, MCAT struggles, public health school, medical school, biochemistry challenges, clinical year excellence, pregnancy during USMLE Step 2, birth, and being a mother in medicine.

I am totally ready for this aspect of my journey. I vow to do great things. So let’s go. Let’s get it. Pediatric Attending status 2015! (happy dance, happy dance, happy-praise dance!)

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.