The special skills we have

Late last night past whatever passes for bedtime in the summer, tween daughter showed me the abrasion on her knee sustained while swimming earlier in the day.  It was the "lane rope monster" known for sheering the top layer of skin of even the best swimmer's hands, knees, etc.  She asked for me to go get her a band-aid.  Size?  Medium.  Our home is well stocked.

After checking to see that the wound was clean enough (no obvious debris), I applied the 2 inch bandage to the extensor surface of her knee, the "bendy" part.  She bent it, as if checking, testing, and then admiring my work. 

And then, with the complete absence of sarcasm (yes, even in a twelve year old) in this, the edge of the end of childhood, she asked if I went to special school to learn to apply band-aids that well.

For the degrees and formal schooling, it was 4 years college, 4 years med school, 3 years pediatric residency, plus public health and medical educator training along the way.  And most importantly, time spent as a mom. 

The other mothers of medicine...

The greats we learn about.  Often men.  Many of us have heard and read the stories of the "Fathers" of modern medicine.

But let's know and share and never forget the story of these women, Anarcha, Lucy, and Betsey.  We might call them the "mothers" of medicine, of modern gynecology.  Alas, these enslaved women whose bodies were used for physician's research. Without anesthesia.  Consent unknown.

Take a moment to listen to this moving podcast at NPR's Hidden Brain with historian and physician Vanessa Northington Gamble, and artist and author Bettina Judd, telling these stories that need to be told.

#blacklivesmatter

Ten reasons this primary care pediatrician is thankful to her patients and families

1. Thank you for asking me questions, listening to my answers, discussing options together.

And for answering the many questions I ask of you.

2. Thank you for brushing your teeth in the mornings.

And in the evenings.

3. Thank you parents, for letting your teens talk with me in private.

I always encourage them to share with you what we discuss.

4. Thank you for asking for refills before your medications run out.

And for using your inhalers with spacers.

5. Thank you for understanding how important vaccinations are for your children.

And for getting your own influenza and pertussis vaccines, as parents.

6. Thank you for modeling healthy behaviors.

Reading, drinking water, minimizing inattentive screen time, and getting exercise every day. Together.

7. Thank you for letting medical students and residents learn pediatrics.

You are their teachers too.

8. Thank you for working on quitting smoking.

Call 1 800 QUIT NOW.

9. Thank you mothers, fathers, aunts, uncles, grandparents, great grandparents, neighbors, and cousins for caring about the children you bring to the pediatrician.
It takes a village.

10. Thank you for sharing your stories, and inspiring me to grow and learn with you.  So we can all be as healthy as possible on this journey.  
I'm listening. 


(an earlier version was posted previously by me at www.pediatriccareer.org and I'm still thankful)

If you're a mother, you've done a lot of research

You're drawing on the literature, you're weighing the risks and benefits of various protocols of parenting, and you're conducting the all important experiment called being a mom, confirming hypotheses and identifying new areas of uncharted territory for exploration.  I'm co-parenting a middle schooler presently, so you can imagine that the data is incredibly hard to interpret.  And the participant has many questions about the plan.

And then there are the other people in my life, the medical students.  They have a lot of (great) questions too.  One thing that many medical students universally ask is why, whether or not, and if so how should they do research in medical school.

This weekend I was at the American Academy of Pediatrics national conference (a local national conference, and so I shall at some point post about the ups and downs of big annual conferences that happen to be in one's own home town).  Before a packed house of medical students from around the country and the world, I served on a panel where we were asked question after question about preparing for residency.   

In the ramp up to the panel, the AAP's young peds network launched a new forum for tackling these kinds of questions and I was asked to write about research during medical school.

• Why is research looked upon favorably by residency programs?  (Is it?)
• Why would it be a good thing to gain research experience? 
• How do you go about getting started?   

Should you get involved in research on the way to residency?  For my take on these questions, see Research for Residency here.  Bottom line, whether you are in middle school or medical school, it's great to search for answers, to delve into a given topic and set about to gain a systematic understanding.  Especially if you are enriching yourself and serving others.

Overheard 10 minutes past bedtime:

SCENE:  just past bedtime;  kids in our bedroom

Husband [pediatric researcher]: "Time for bed."

Daughter: no movement, keeps on reading

Husband: "Time to go to your room, please go to bed."

Son: ignores him as well, keeps on jumping around expending all remaining energy

Husband: calm, cool, collected: "Get in bed, STAT."

Repeat, qHS

That way you talk

I was in the office speaking with a parent and her kids at some point in the past year (how's that for sufficiently anonymized).  The mother was gazing at me for just a little too long.  She could have been pondering my most recent question, or may have been lost in thought, but at that moment I opted to ask her gently if she was okay.  And she simply said, "I'm sorry, I just love the way that you talk with my kids."

Oh how that made me feel that I'm right where I should be and doing what I should be doing.  She saw the way I really ask, really listen, and aim to motivate. It's working, at least in this case. 

You've probably heard similar positive comments from time to time about how you communicate with your patients.  And yet, if I could only do so at home!  I can be ever so calm and motivating, building partnerships, and serving as a measured and informed voice of reason at work.  And while I want to consistently do the same at home, I CAN'T HELP YELLING. AT MY KIDS. SOMETIMES. GOT TO WORK ON THAT.  You?

What's your idea of fun?

Our health centers are “medical homes” now, so I have to come to accept (but not necessarily embrace) my allotted turn or assignment to work, i.e. see pediatric patients, on an occasional Saturday. Periodically, I am able to trade these away, so they end up being few and far between. After a full day of patient care on a recent Saturday on a recent 3-day holiday weekend, my family (me included) were out to dinner and a colleague happened to be picking up dinner at the restaurant where we were dining. She came over to make small talk, and I mentioned I'd just come from working the whole day.

My young son then chimes in with, “But mom, for you, work is fun, so it’s not so bad.”

And that got me thinking about whether or not it is fun. Of course, there are all kinds of fun. Family fun is our recent amusement/water park trip, swimming in any lake, ocean, or gorge together, and family movie night. My individual "fun" is going on a long run, doing the Sunday NY Times crossword puzzle, or simply sleeping late.

But the perception that work is fun has got me thinking. Indeed, a lot of pediatrics and teaching is, when my patients giggle and the toddlers talk and my students are inspired and inspiring. And my work is gratifying. It feels meaningful. But at times it is heart-wrenching. I’m intrigued that “fun” is how I portray my work to my children, or that this is how they perceive my orientation towards what takes me from them day to day. That this one word (fun) has encapsulated their mom’s chosen career path.

Nicely done?

Went to the pediatrician with my daughter for routine primary care visit.  I thought she (the pediatrician) did such a good job with my daughter in terms of the tenor and content of the discussion, the calm demeanor, the subtle but savvy questions, the listening, and the encouragement.  Promoting wellness, self -esteem, and balance.

Later in the evening, reflecting back on the visit (and talking with my spouse) I realized how similar the pediatrician’s approach seemed to my own approach with my tween patients.  Or at least was what I aim to do.  But then I wondered about how circular this is.  I like the pediatrician because she practices like I do. How self-congratulatory is that?  And yet, perhaps instead it's that she and I are similarly mediocre pediatricians. Regardless, my daughter stated after the visit that her pediatrician was the “best pediatrician ever.” (Present company excluded, of course.)  

Do you learn about doctoring when, as a MiM, you go to the doctors?  I have tried to over the years. And as a MiME (Mother in Medical Education), I teach some stuff too. Actually, we chose this pediatrician in part because she trained with us.  More circularity.  Nicely done!

The Question Box

As a pediatrician who is constantly answering children’s questions --my own (staving off bedtime) and my patients who ask everything-- I love Red Humor’s approach of simply and directly answering the “landmine” questions her children ask, in her recent post.   Her post artfully discusses questions about our treatments for people who are very sick, some of whom get better, and some who don’t.  Sometimes when kids ask where people go after they die, they may be asking literally, what happens to their body, see this from KidsHealth and this from the NIH.  There’s a list of books at the end, and a favorite that I can’t get through without crying is The Tenth Good Thing About Barney by Judith Viorst, or even The Giving Tree by Shel Silverstein (just about growing older).  It’s okay to let them see you tear up (and then feel better again) if you are so inclined.

About 3 years ago, stemming from my sister the philosopher, I had written a post here about "mothers who lie" and creative mothering.  But a friend of mine used another idea that works sometimes called the "Question Box" which you can use when you either don’t know the answer, or you don’t have the emotional energy or the actual time needed to fully answer, or you want to bring in your partner on the answer, or if you are asked something very private in a very public place, and so on.   It goes something like this, “that is such a great question, here is a short answer now, but I think we should write that down and put it in our question box so we can answer it more fully this weekend when me, you, and daddy are all together” or “…so we can look up the answer in this great book I have on the human body” or “I don’t think I have a good answer to that right now, but let’s make sure we look it up together.”    But then you have to get to that question box at some point!

Another fun approach to a different kind of question box question is to just lay it out there, “You are never going to believe the answer to this question” and then go ahead and tell them exactly how that baby really comes out of the woman’s body.  Tell them the people in their 2^nd grade class at school may not know this information yet, and they can wait until their own mommies tell them the answer. And, you can wait a wee bit longer on telling them how the baby gets in there.  Just the facts, ma’am.

It’s about creative mothering and telling the truth.  And being in a special place because of what we do at work every day.  And being there for our own children’s growing minds and emotional development.  With lots of questions and some well-timed answers.

Who did what?

As a physician, I remember countless patient's details and stories, and as a medical educator I remember student's sagas, issues, and triumphs.  But I have an EMR, chart-stimulated recall, notes.  

At home I have an imperfect record.  I remember the beautiful moments and the laughter and the tears and the growing older as a family, but I sometimes forget which child's nursemaid’s elbow I reduced (3 times).  Which of my 2 children used to grind teeth at night?  Which one wouldn’t let us take the band-aid off for a month after an influenza vaccine as a toddler?  I know who had the UTI (she did) and I know who had the early --now outgrown-- milk protein allergy (he did).  And I know that she now swims, plays guitar, and reads about as avidly as she eats macaroni and cheese. And that he is now a drummer and a young scientist wise beyond his years.  My two are so distinct from one another in many ways, and yet I've forgotten whether it was my son or was it my daughter who erroneously pressed 9-1-1-send on my cell phone.  Come to think of it, they both did that.  Then again, even at 7 and 9 years of age they sometimes call me "dad." And I’m okay with it.  The memories meld together, and the love is shared.  

Does it always matter who did what?

How medicine changed me during the snow and ice

I am in medicine, where I must get out of bed and leave home on a “snow day” after arranging care for my own kids, to de-ice my car, commute through snow, sleet, and freezing rain, so that I can be available in person for my patients.  Before medicine, I would have probably lounged around, woken up late, and perhaps taken a walk just to enjoy the snow.

As a medical professional, I have responsibilities rain or shine. Just like a post officer, "neither snow, nor rain, nor heat, nor gloom of night stays these couriers [read: medical professionals] from the swift [read: caring and comprehensive] completion of their appointed rounds." The mother portion of me as a mother in medicine feels particularly bad leaving my family on a snow day. The medicine portion of me as a mother in medicine feels good, to be in a service profession, indeed.

(And maybe we'll get out early, in time for some twilight sledding.)

Do you have 5 year plan?

When asked this recently, I fumbled.  Actually, I tossed back the answer, asking the asker to mentor me through getting such a plan.  It wasn’t even someone who knew me well and it had been asked in a fairly casual way.  Regardless, I was not able to answer the question.  But if I were to answer it, the answer would be, “No I do not.”

I feel like my personal plan is on track, I have some goals which essentially these include some family fun and fitness.  But in the professional arena, I don’t have a 5 year plan like others do.  Do others have a 5 year plan? 

I have quite an accurate 5 day plan.  My calendar is reasonably organized.  I'm a list writer, whether on paper or on a smartphone (actually, both) and an avid list crosser-offer.  Sometimes I'm tempted to add things just so I can cross them off again once completed.

Flash back 5 years ago, I don’t think I actually had a career plan to get to where I am now, though I am where I want to be.  I was "finished" with the relatively more well-defined years of college, med school, residency, public health school, educator-leadership program, (can you say "perpetual trainee" or more generously "life long learner"?).  Career-wise, I think that mostly things have come to me through plenty of hard work, but admittedly with some luck, good timing, and strong collaborations.  Now I’m trying to think about what will come next.  Not that I’m at a mid-life crisis per se, but just that if I try to map out what’s coming up, what should happen, what I’d like to do or explore professionally, I’m just not sure.  I feel like I can (and do) help others along with theirs, but not sure of my own at this point.  In academia there are peaks, valleys, plateaus and mountains to climb.  I am hoping I can find the right trail.  The journey is still interesting, made more interesting by taking part in mentoring others, even as I continue to pave my own way.  I have a vision of what I might want to do but I'm not sure how to get there or if it's feasible.  I continue trekking onward. 

Do you tend to let things happen and see what unfolds along the way, or do you have a plan?

How's your summer?

Since you asked...  If it weren’t for her dose of chemotherapy q 3 weeks and some iatrogenic wbc-boosting induced bone pain, it’d be fine.  And yet, my mother and I are still having a reasonably good summer.  Slowing it down a bit and being together.  Even if the togetherness is while we have a picnic in the chemotherapy suite, or while we walk to the local pharmacy to pick up a medication refill. 

Because nothing says bonding with your mom like shaving her head.  She reminds me that early on I’d wanted a career as a hairdresser.  Alas, now there is no hair. But to my pleasant surprise she is the same strong, smart woman with or without her hair. 

Hats abound.  Tennis caps, floppy sun hats, indoors or outdoors.  They suit my athletic mother --who scheduled her first chemo treatment around her tennis game-- better than a wig.

So how’s your summer?

Taking it one day at a time.   Fortunately or unfortunately, I can conjure up that old car commercial ("this is not your father’s Oldsmobile") and say this is not my father’s chemotherapy.  That was another summer 20 years ago, a different regimen, and for an incurable disease.  This time around it’s like cancer 2.0 with a better chemo concoction and a much better prognosis.

And how do you like this summer heat?

I’m trying not to sweat the small stuff, but sometimes I have trouble figuring out which is the small stuff.  Even now, when I should have perspective on what matters most in life.  Sometimes when I’m stressed about the big stuff, the small stuff makes me sweat too.  I’m working on it.  And overall, it’s been a good effort in rebalancing.   It’s mid-summer and there are lots of balancing acts, being here in the middle.  As I am a doctor but not her doctor.  As I care for mom and am a mom.  As my mother cares for her mother and for her daughters and for her grandchildren.  Chemo more than halfway done and yet other treatments still ahead.  So we try not to sweat the small stuff.  Unless it’s while on a jog or on the tennis court.

Why doesn't your mom just...

Setting:  tree pollen infested suburb of our nation's capital, springtime

Characters:
son's friend (unaffected) 
son (with puffy eyelids and superficial excoriations on arms/back/legs)
mom (pediatrician, imperfect)


Act I: morning, breakfast

MOM: (places drops in son's eyes, sprays up son's nose, 10 ml syringe generic nonsedating antihistamine in son's mouth).  Have a good day, sweetie.

SON: (blinking, sniffing, rubbing, scratching...  yet smiling.)  Thanks mom.


Act II: school, lunchtime

SON'S FRIEND:  (inquisitively) Hey, why doesn't your mom just take you to the doctor?

SON: (emphatically) Because my mom is a doctor.



                --  The end --


Summary:  A mother in medicine recognizes that despite everything she (as a pediatrician) knows how to do, and everything she (as a mother) wants to do for her son, she is imperfect in her ability to cure all.  Drops, sprays, creams, liquids for her patients...  plus kisses for her own son.

Epilogue: This mother in  medicine recognizes, more painfully, that she cannot prevent or cure cancer in her own parents. She can understand and translate the fast talking teams of surgeons, anesthesiologists, oncologists, radiologists.  And she can be there with support, a lot of love, and a little laughter amidst the tears.

Being introduced

My mother, not in medicine, and this mother in medicine, went to have a biopsy.  Her biopsy.  By a surgeon.  I am not a surgeon.  Nor am I a doctor for adults.  My day to day is infants, toddlers, school-aged children, tweens, and adolescents.  And medical students.  

How does your mom introduce you to her doctors?  My mother introduced me to the surgeon whom she herself was just meeting at that moment, as her daughter.  Sounds reasonable.  Started off well.  Though this was immediately followed by, “she’s a pediatrician.”  I paused briefly at the stark declaration, and softly came up with, “…who knows nothing about what you do.” 

Why did I demur?  Why so modest?  The surgeon and I might indeed speak the same language (though she much more tersely).  But I need not hover, make her nervous, nor imply that the reason I’m there is because I’m a doctor too.  The reason I was there was to support my mother.  As a daughter.

But alas, I guess I was also there because I do speak, or at least understand, that language.

[Results not in yet.  Somehow felt okay to post here on MIM in the interim.]

the other parents in medicine

Just got to thinking, is there a fathers in medicine group blog? 

Fathers in medicine who are reflecting on their careers, their choices, their balance or perhaps lack of it, their children, their partners and families, their co-workers, their time off, their time on, their weekends/evenings/late/early meetings, their yearning to breastfeed or pump (!), their commute, their biological clocks, their practice, their burnout, their paycheck, their research year, their struggles, their stresses, their joys, their tears, and...   

reflecting on us mothers in medicine, of course.

What else might they reflect on?

It's been a while

It’s been a while since he died.   

And yet…   

He is with me daily as I see him in my children, in my own interactions (when I’m at my best), in how I organize myself, in how I enjoy life, still.  

A marker of time passing.  I have now been alive for longer without my father (alive) than with him (alive).  

He did not live to see me in medicine, as a mother, married, making my way.  

And yet…

As a feminist father, back in the day, he helped me know I could be who and what I wanted to be. He was a kind and patient person, who listened, who cared.  Like everything you would want in a doctor, though he was not in medicine himself.  Like everything you’d want in a father of a mother in medicine.

Did I tell him thank you?  I can't remember.  I hope so.

Which comes first, the pet (companion animal) or the child (companion human)?

Most MiM's probably consider themselves mothers to human babies, toddlers, teens, or to grown children. But a MiM might also be "mother" to a companion animal, i.e. to a pet.

Which did you (you alone or you and your partner/spouse) have first?

The pet as practice for a kid?
The kid as practice for a pet?

Some upsides and downsides either way. Can't learn to breastfeed (or pump) with your pet, but can learn to be responsible, to love a helpless being, to nurture, to teach/train/grow up another living lovable animal.

Toilet training <-----> litter box
Diaper changing <-----> pooper scooper
Taking for a walk <------> taking for a stroll, and then alas those first steps!
Doggy day care <-----> child care

The challenges and triumphs. The shared responsibilities with spouse. The work-family balance. The feeding, sleep training, getting up early, staying up late, clipping their nails, bathing. Not sure if anyone reads to their pet, like they would to a child, but could certainly sing to either!

Taking them to the vet/pediatrician (the two are periodically confused, for that matter). Does a MiM do some of the medical care for their own pet like they might for their own child?

We had our children first, and then (at the daily, no make that TID urging of daughter) brought a bunny rabbit from the local humane society into our house. Was not even a difficult transition (the more the merrier) and quite a learning, loving, sharing experience for us all. The bunny eats better than the daughter (way more kale, greens, carrots). We don't attempt to provide vet/medical care for our bunny (not qualified!) and are recognizing the importance of primary care. Son and daughter aren't quite sure (it changes day to day) if they are "mother and father" to our bunny, or big siblings to the little guy.

Which did you have first, and why?

overheard, son in bathroom, reading my journals

"Mom, you've had that Pediatrics in here a long time," says 5 year old son in the bathroom, seeing my copy of this journal on the step stool aka magazine rack.

"But you know what? I get a new one of those every month in the mail," replies MiM from the kitchen.

"Yeah but this one's been here waaaaaaaaaaay too long," he persists.

Time to get reading? Get the dust off my journals? Move it to my bedside table? Get an iPad/e-reader?

Pediatrics is kids and family

How could I have almost passed up the opportunity to post on topic week about a family friendly career? Perhaps because this week I baked for the kids’ school pot luck and bought gifts for their amazing after school counselors and am working on a grand rounds and revising and resubmitting a paper and tweaking the students’ syllabus and conducting meetings with…

All that, and yet pediatrics, the career, is kids and their families. And as such it could not be more supportive of pediatricians raising theirs. Lots of opportunities for part time work, though I have remained full time with enough of “protected” time for non-clinical but otherwise scholarly work, where much of the flexibility is built in.

I aim to be a serious academic and medical educator (albeit still with appropriate levity with my pediatric patients) but at my own pace. After a few “wins” (first grant, first publication, first leadership role) you can pace yourself, pick and choose things (still say yes to almost everything but learn to say an occasional no) in academia. And grow to be a mentor to others.

And all the while my pediatric colleagues have to understand things like pumping, breastfeeding, being called to get your son from daycare, fevers, falls, school performances, and sports events because this is the stuff of outpatient pediatrics. It happens in our lives as mothers (and fathers) in medicine as it happens in the lives of our patients. When I returned from parental leave after 16 weeks the second time around, squeezing in pumping and speeding to daycare pickups, I reassured my boss that that was the last baby for me, and he told me to have as many as I wanted. That was a breath of fresh air (and the legal thing to say), and it was sincere. I continue to have all my patients as “my kids” plus the two of my own, and that is the right number for me in my very full time pediatric parenting career/life.

I think a side benefit of pediatrics as family friendly is it helps in child rearing. You learn the tips, the things we parents struggle with, you read the latest on development, and you can even draw upon your job when you minimize your kids’ screen time, ensure they brush their teeth, buckle up, among other less obvious things. I have nearly said to my children, “If your parents weren’t pediatricians then maybe you could eat that hotdog while playing with matches and then take a ride in the front seat, but….” Furthermore, my children hear me take call by phone some evenings or weekends for our outpatient community-based academic pediatric practice and have nearly become mini-pediatricians themselves. Even though they’ll probably be a rock star (say, Elvis) and an artist (she who draws mostly mermaids).

I didn’t choose pediatrics because I thought it would be family friendly, but much to my joy and satisfaction, in most cases it can be and has been.