Showing posts with label guest posts. Show all posts
Showing posts with label guest posts. Show all posts

Friday, November 18, 2016

Guest post: Our scars are our torches

Women are mothers, teachers, healers, and crusaders. We are slowly entering a revolution for women where sexual assault and abuse are a topic of national conversation now more than ever before.

Let me tell you a story about myself. When I was 14 years old, I had my first chaste kiss at a summer camp where I was volunteering. When I was 15 – I was a junior in high school that year, moved ahead for academic reasons - I was asked to a Christmas formal by a 17-year old boy who had just transferred to my school from another state. I was shy and introverted and hadn’t dated much so was thrilled; he was very handsome. We went to a party after the dance where there were no parents and alcohol was in abundance, but I wasn’t very experienced with it so I only had a few sips. Any slight head change was immediately extinguished by excitement when he asked me to go to a park with him in his car and make out. I hardly knew him but was heady with youth and the clear starry night and the possibility of fun.

In the car on the way to the park – a park that happened to be across the street from my house, we had the windows down and the wind was whipping through my hair. He put Bad Company in the tape deck and I was pleased because I knew the words to a lot of the songs and I have a decent singing voice I was proud to show off. We pulled into the parking lot and awkwardly started to do what a million 15 year olds do every day and it felt wonderful.

Then something happened; it took a turn for the worse. He got rough, and I wasn’t prepared for that – what to do, what to say. I don’t even think I knew there was a name for it at that age. I tried to push him away. My clothes were torn. He became violent. I remember staring off into the trees, trees I had run and played under when I was younger, trees that had sheltered me from the sun at the adjacent swimming pool for many years, trees that still shelter me now from the memories of that experience. I disappeared into the moonlight as it shone through the trees. As an adult I know this is dissociation. As a teenager it allowed me to go on.

When it was over he offered me a ride home but I opened the door of the car and ran. I hid behind some bushes and stared at the front door of my parent’s house until it was light enough outside to go knock on the door, pretending that a friend had dropped me off after a sleepover. I have no idea how long I waited, but it must have been hours in retrospect. I remember aching with pain and dripping blood on the ground as I leaned against a fence and peered through the leaves, still frightened since I was alone in the dark. I finally gathered the courage to knock and when someone opened the door, I hid the areas of my torn clothes with my hands as I rushed up the stairs to my room. I cleaned myself up in the bathroom with the door locked. I called a friend from another school in another town and told her that all men were brutes, and that I would never trust them again. I was too ashamed to tell my parents.

I convinced myself that it was my fault; that I had asked for it. I wore turtlenecks to school for weeks until the bruises healed – luckily it was winter so it was easy to hide them. I managed to make his presence, one that persisted until graduation, invisible to me. I beat myself up inside my head for singing “Feel Like Making Love” on the way to the park – I still cannot listen to that song and have to change the station or remove myself from the situation if it starts playing on the radio or at a restaurant or bar. My singing that song felt like giving permission for what had happened, even though the words were in no way a description for what occurred.

I beat myself up even worse when a six-foot tall confident blond tennis player asked me how my date with him went – he had asked her out. I told her it was fine, didn’t meet her eyes, shrugged my shoulders underneath my turtleneck, then turned around and walked away. She angrily sought me out the next week because he had tried to lock her in a room and assault her and she had to kick and scream and fight and forcibly push him away and run through a door to escape. “Did that happen to you?” She asked angrily. I shook my head no and burned with shame. She got away, I thought. She is stronger than me. I’m a failure.

Predictably, my mental health deteriorated. I became so thin and pale I looked like a ghost of myself. I became a career bulimic. I started having suicidal thoughts. A teacher was worried about something she saw in my private journal for writing class and alerted me that she was going to talk to my parents. This was my breaking point. One of my parents walked in on me trying to slit my wrists with a steak knife that morning. I didn’t want to end my life, they were just chicken scratches; a cry for help. It was a necessary turn of events to get me into counseling.

I finished my senior year of high school and graduated at 16 as Valedictorian. I went to a month of inpatient rehab for bulimia and learned that I was raped and was able to tell my parents. I still carried the shame, but started to gain some weight back. I found the courage to go to the police station and report the incident with my mother by my side, and was happy that the statute of limitations was up so I could not prosecute; that would have been too painful just as I was starting to heal. I felt I owed my statement to other women: to the tennis player I wasn’t able to protect from his violent advances, to any future woman he might assault. I was proud.

I started college close to home; I wasn’t strong enough to move away. I learned by word of mouth about two other women my perpetrator had sexually assaulted. I watched the Clarence Thomas/Anita Hill trials and patted myself on the back internally about not speaking out. I walked on the sidewalk the morning after a No Means No demonstration – they had painted it in colorful sidewalk chalk all over campus. A group had snuck out in the middle of the night and wrote “unless she’s drunk” after half of the statements, and I patted myself on the back for keeping silent and not going to those demonstrations.

Once I learned that my perpetrator had come to a college party I was attending and I my normally passive self physically fought my college boyfriend to keep him from going to beat him up. “Take me home now,” I screamed at him while pulling his arm. I didn’t want a scene I wanted out of the situation. It took four of his friends to help me hold him back. He finally took me home and I cried in a closet.

After graduating Magna Cum Laude, I had a brief stint as a psychiatric counselor at an inpatient child and adolescent ward before starting medical school. I read the files of 5 and 6 year old children who were being used for child pornography by family and friends and then went to tuck them in for bedtime. I remember one little boy grabbing my head and forcibly kissing me on the lips and trying to put his tongue in my mouth. I tried to hide my shock not to hurt his feelings, teaching him gently with my actions how to give a proper good night hug and peck on the cheek. Two days later I held him in a basket hold in the safe room for over an hour so he wouldn’t hurt himself or another child. My relief was palpable when he finally fell asleep in my lap.

On the adolescent side, I met a girl who was 13 and pregnant. This young girl the same age as my daughter is now was so proud of the pregnancy because she had been “sexed” into the gang. I learned this meant she was gang raped, and that because she got pregnant during the gang rape that the child was a child of the entire gang, and her status was elevated above other women in the gang.

I went to medical school. I listened to a friend talk about being sexually harassed by a surgeon, all the nurses around rolling their eyes as if to say “that’s just him we put up with it,” and decide not to report to protect her future career. I watched her decision reinforced when a student reported a notorious sexually harassing doctor, one that I intentionally stayed away from, only to become the butt of every joke on campus. I became a doctor. I listened to a friend share in residency about an attending who was sexually harassing her in a creepy way and the department’s solution was to keep her away from him – to not put her on any rotations with him. I later learned the creepy attending was transferred to another academic institution after a surgeon learned from his tween daughter that he harassed her at a school bus stop. So this is how they take care of this, I thought. This is so crazy.

I became a wife. I became a mother. I got divorced. I went to therapy, again as an adult. I’ve never asked or heard what happened to my perpetrator. Thankfully he has not attended any class reunions.

After a few years of dating my current boyfriend, we became engaged. I’ll never forget the first time I told my fiancé about the rape. We had been dating about 6 months and things were getting serious. I was terrified of his reaction; terrified he wouldn’t love me. It was the middle of the night; we were on a long weekend away. I went to the porch of the bed and breakfast and stared into the trees watching the moonlight. I drank a glass of wine and gathered the courage. I crawled back in bed with him, woke him up, and we started a conversation where he told me he loved me. I awkwardly confessed that I had been raped. He looked into my eyes and said something no one has ever said. “I’m so sorry that happened to you. Want to tell me about it? I’d love to listen whenever you feel like it.” Tell my story instead of sweep it under the rug, or awkwardly dismiss it? I felt like I had been doused with a bucket of cold water. I found the courage to tell him I loved him back, and shared a truncated version of this story.

It’s not men’s fault that they don’t always find the right words when hearing about sexual assault, or women for that matter. It is hidden in a cult of guilt and shame, passed down generation after generation. Women are speaking out now more than ever before: carrying their mattresses across campuses, trying and more often succeeding in prosecution. Every time I read a story about a woman with a successful prosecution, I cheer silently on the sidelines as a member of her team. Every time I read about a woman who is penniless and suffering from mental health disorders after being kicked out of the military, her bright and promising future doused by rape, I cry silently on the sidelines as a member of her team.

In therapy I mourned my lost innocence. In solitude I forgave the little boy who grew up in a house where the possibility to do what he did to me was transformed into a reality. My therapist told me that my empathy did not need to extend to my rapist, but I couldn’t help it. And in some small way, it helped me heal.

We need to remind men and boys that the porn they can so easily google as a teenager at a sleepover is not reality. We need to tell them if they are in a gamer chat room online and a girl walks in they cannot verbally assault her just because everyone is anonymous. They cannot rape her at a college party, even if she drinks too much. They cannot call her bad names and treat her with disrespect, even if they witness it growing up in their own house.

This is a cultural ill. We need to change the fact that women on Indian reservations are so easily raped by men who know they can escape prosecution. We need to change the fact that sports institutions objectify women and value the achievement of their college and professional athletes over disciplining those that have no boundaries with women. We need to change military culture around women. We need to stop human trafficking. It’s a worldwide disease, and our country may be healthier than some, but it is still very sick.

Last week the election of a president that boasts of sexual assault and promotes intolerance and hate struck my core as a human being, but also hit me on a much more personal note. I woke up at 5am and the confirmation of what I dreaded was happening at midnight spun me into outer orbit. I sat on the back porch, had a glass of wine, and sobbed. It felt like decades of achieving and therapy and reaffirming my worth in society was erased by half of America.

A few days later I sat in a Sunday school class with a group of strong, mostly single mothers and was reassured. The current leader (we all take turns – well, them anyway I’m a slowly reforming atheist looking for faith who does not yet feel qualified to lead in this arena) spoke of a Saturday spent in a prayer house. She, a Methodist, said that she was reminded by an Episcopal leader that all lives have value, and that we spend too much time, especially in America, measuring our value by our achievements and our wealth.

She spoke to my 15 year old soul. That girl had promise and value – no different from the doctor I am today. That incident no longer defines me, but it does shape my future actions. I vow to revolt against hatred, not with anger or blame, but with love and action. I vow to value every human being I encounter no matter their origin or political inclination. I vow to use my scars to help heal others.

-Anonymous

Friday, July 15, 2016

Guest post: Tampon Travesty

Another cycle. It's here. The anxious two week wait is over, and it's time for tampons. I got my period.

There are many blog posts and stories about struggling with conception. But these people aren't in medicine, they aren't in sync with the uterus, right?? They didn't have to memorize hormones and fun facts?? Right? Apparently not.

Well, we started struggling, and the foreign stories became relatable. Our trials have been so much more confusing in light of our son who grows older with every month we are unable to provide him the brother or sister I have longed for since the moment he was born. I guess they call this secondary infertility - I call it a giant, expensive, heart-breaking pain in the ass, which makes me cry on a regular basis, well by regular basis I guess I mean... approximately every 28 days.

We have been trying since our son was first born. We both want a big family, and that requires trying to have children, even during our simultaneous medical training, and what some would say are not ideal times. So, I gave up breastfeeding my son cold turkey (with ample frozen milk) to expedite my cycles returning. Well, they returned... and have been returning for close to a year now. I could have had my baby by now. I could be back to breastfeeding and snuggling, but instead I'm changing my own maxi-pads. I'm a strong woman, but this was not my plan, and I cannot will it away, or rely on our shared medical knowledge to fix the problem.

I know you're supposed to wait to see a reproductive specialist until a year, but waiting is not my strong point. We went a few months early, and are actively seeking care. It is hard to seek care as medicine folk. We are knowledgeable, but vulnerable. We want that second child so badly. So, we shall let the medicated IUIs begin.

I'm not sure why I'm writing this, but it sure feels wonderful. Partially, for my own sake and partially to break the silence of infertility. Here's a shout out to all my medical mommas trying to grow their family. A wish of wellness and fertility to all those trying and especially those struggling.

May the second pink line be with you.


MD/PhD Student Mom + Anesthesiologist Husband + One Son

Friday, July 8, 2016

Guest post: Jury Duty

I have a confession to make: I'm currently on day 2 of 5 weeks of grand jury duty. Yes, 5 whole weeks.

I write it in those terms because I feel embarrassed and ashamed every time I tell people this. When my family, friends, or coworkers hear that I am serving 5 weeks of jury duty, or when I mention to my fellow jurors that I am a Veterans Affairs physician, they respond with shock, "I can't believe they picked you!" or they make some sort of twisted, disgusted looking face. The impression that I get from them is outrage that I'm abandoning my patients and -- though this may simply be projection of my own feelings -- that I should have tried harder to get out of this responsibility.

I received my court summons 2 months ago and right away, I notified my supervisor to ask for guidance. He replied that I should just close out my clinic so no patients could be scheduled. My colleagues assured me that they would cover. I thanked them, but reassured them that I likely wouldn't be selected. I admit that part of me was ambivalent; wouldn't 5 weeks of jury duty be a welcome "break" from the grind of clinical medicine?

Fast forward to earlier this week. I sat in a crowded court room and soon realized that I had been called for grand jury, not petit jury, and that the two are very different. Petit jury, I have now learned, is a trial jury that determines a person's guilt or innocence. I had been summoned for petit jury some years ago and after sitting in a large room for several hours, I was dismissed without ever being called for "voir dire," which is when the trial lawyers question prospective jurors about their backgrounds and potential biases in order to select or reject that potential juror. Unlike petit jury, the purpose of the grand jury is to determine whether there is enough evidence to indict a person of a crime. Also unlike petit jury, there is no voir dire for grand jury (although I did not know that going in!).

Anyway, during the initial process of grand jury, the clerk asked for anyone who believed they couldn't serve to step forward. She explicitly stated, "Occupation is not a reason why you cannot serve. You can be a lawyer, police officer, law clerk, married to a lawyer, etc and still have to serve." So when I heard that, I stayed in my seat. She went on to list several valid examples of why a person might not be able to serve: medical or mental health issues, financial hardship (if a job wouldn't pay during jury duty), illiteracy. I thought, "No, no, no" and stayed in my seat with my nose in my laptop. But soon I noticed that the crowd had dwindled, and I became nervous. There was a break, and when we returned, the clerk asked if anyone would have an issue hearing cases related to sexual or domestic violence. I am a psychiatrist at the VA and care for a large number of female veterans who have experienced "MST" or military sexual trauma, but I thought, "Hey, I can be unbiased." I honestly felt that the question was directed more towards people who had been victims themselves.

So the next thing I know, I'm being sworn into grand jury duty with 22 other people! I couldn't believe it. I kept waiting for the voir dire, but at that point learned that grand jury doesn't have a voir dire process, and by then it was too late. I spoke to the clerk later that day, and she basically said as much: "Too late, you're sworn in now and you can't get out. Why didn't you speak up before?"

So that's the question I've been asking myself the last 2 days. Why didn't I speak up? As a psychiatrist, I've been trained to wonder about unspoken desires and ambivalence. I think part of me did see jury duty as a break. Yes, it's an inconvenience to my routine, but the day starts an hour later than my clinical day and often gets out early. It's nowhere near as mentally or emotionally exhausting as patient care. There is also a lot of downtime between cases when I can study for my upcoming board exams. And the courthouse is in a part of downtown that I don't normally frequent with lots of shops and restaurants.

So for all those reasons, I'm feeling guilty -- guilty that I put my own interests before my patients' needs. Yes, I had notified most of my patients that I may be out for the month of July. I don't do therapy, and I see most patients every 1-3 months, so I didn't have to disrupt weekly sessions. Yes, no patient appointments were actually cancelled. Yes, I have amazing colleagues who told me not to worry, that they would cover any emergencies that came up and see new patients during my absence. But I still feel like I am shirking my professional responsibilities.

I know jury duty is a civic duty. And just by being on jury duty the past few days, I can certainly say that I am contributing to the group diversity in terms of race, age, socioeconomic class, and education level. It is actually quite eye-opening and frightening to think that probably most highly educated and professional citizens get out of jury duty, which leaves important legal decisions to be made by people you might not want to be making important legal decisions. Thinking in economic terms, what's the opportunity cost of a good juror vs. of a physician, lawyer, or other educated professional? What's lost when a doctor is out of clinic vs. when an uneducated person is chosen for jury duty? I guess you could say, "Well, a doctor went through 7-9 years of post-college education to get here and is helping sick people, so their time is worth more than any Joe-Shmoe who could serve as a juror," but then is that fair to the defendant? Would you want a Joe-Shmoe to serve on a jury if it were your case? Can you really say that someone's health is more important than whether an innocent person goes to jail or a guilty person goes free?

I'm seeing that there is no clear answer, but all I can say is that I am still feeling pretty lousy about being on jury duty. The cases have been interesting, but I feel guilty being here and inconveniencing my patients and my colleagues and for getting this "break."

What would you do? How do you handle jury duty summons? Have you ever served? Do you think physicians should be exempt or always try to "get out of it?"


~~~~~
Bio: I am a new attending psychiatrist at the VA in a Mid-Atlantic city, studying for my board exams in September and mothering 2 young sons.

Thursday, June 23, 2016

Guest post: Have baby, will travel

I had my first baby during medical residency, where we were allowed 6 weeks off (including all the year's vacation) without extending leave. My daughter was, ahem, rather "colicky" (read that as "screams for no reason unless being walked on your shoulder for hours a day, or possibly asleep on mom"). I love her but after 6 weeks I was sick of watching Law-and-Order by myself at home (boo hiss lack of US paternity leave support), and starting back into a relaxing research rotation was a relief. Even if it was hard to find a private place to pump. With number two I vowed not to isolate myself so much. To go out and about more with baby, even if it meant breastfeeding in public a bit. (I was just too self-conscious to do it with number one, even with a sheet) So, while pregnant with number 2 during my first year of Oncology fellowship, I realized ASCO (the big annual oncology conference), which I very much wanted to go to, would occur about a month and a half after he was due. Should I go for it?

Being a mom in medicine feels like a mixture of wanting to have my cake and eat it too. I want to work, I LIKE work. I want to have babies, I LOVE my babies. I want to breastfeed exclusively. I hate pumping. I'm going stir crazy after a few weeks of being a stay at home mom. I'm incredibly anxious about the prospect of leaving my baby. It's so nice to be among adults and using other parts of my brain again. Etc.

So, should I plan to go to ASCO?
With a one month old?
While breastfeeding?

First I did a Google search. I found a few articles on graduate students going to conferences, and that people were generally supportive. But nothing specific on ASCO. OK.

Could I keep the baby on me with a sling? Run out if he starts to fuss?

Sadly the answer to that is very much NO. ASCO does not allow any children under 16 in the conference, for "safety reasons." No exception for pre-mobile and breastfeeding babies.

So, I would say it's mostly impossible to attend ASCO if you don't have some kind of secondary childcare arrangement.

However I am incredibly lucky in that my parents are in Chicago, close to where ASCO is held. I was planning to stay with them anyway. My father no longer works and is very supportive. So, I did go with my baby to ASCO, and it was a good experience. Here's how I made it work.

1) Knowing my priorities. For me, my baby and establishing breastfeeding was my number one priority, so if there was a conflict I would choose that. Anything I got out of the conference would be gravy - some conference would be better than no conference, I reasoned. Especially since given the timing of my baby's birth, I was actually still on my 6 weeks of maternity leave while at the conference.

2) Having on-site childcare. In my case, my parents. What we ended up doing was, I went to the conference center with my father and my baby with a stroller full of supplies; there were a lot of common areas we could all go to. I would go to sessions, my dad has a book (did I mention he's tremendously supportive??!). When the baby got hungry and fussy, my father would text me and I would dash out to feed him. There was a first aid station where I could go nurse in privacy. I had my nursing pillow stashed with the diaper bag in the stroller.

3) Only go in-person to the in-person stuff: At ASCO at least, the talks are streamed online! So I could watch those in the luxury of a living room with some water and nursing a baby any time after the talk happened. There's really not much interaction at the talks, in fact sometimes the sessions are so full you end up running from room to room to watch it streamed. The poster sessions, on the other hand, I could read online beforehand then go and talk to the presenter one on one. Bonus, I could run in and out without any issue! I identified which sessions would be most valuable to me and went to those, running out for a half hour here and there when I got a text.

-- I did miss out on the "fellows lounge" as I did not know about it, apparently a good spot to be. Maybe next year!

Things that wouldn't work:
-- not having on-site childcare
-- pumping. Unfortunately the first aid station did not have a breast pump, you have to bring your own. And the site is HUGE. I did try to go one day on my own with a pump, and hauling all the supplies around was just obnoxious. They don't even let you stash them at the first aid station. So I can't recommend that.

Overall, I got to visit my parents, they got to see my new baby, I still breastfed and was with my son constantly, AND I was able to make a few connections and learn about some of the latest data on immunotherapy in different cancer types. I would definitely recommend it if you can find the support.

-Proliferating Oncologist, a first year hematology-oncology fellow.

Monday, April 25, 2016

Guest post: The Wandering Mind

The way my mind works as of late is akin to that of the ‘Tasmanian Devil’. I am constantly shifting focus. As a hospitalist, and probably like a lot of other types of physicians, I find myself switching my train of thought often every minute. Triggers of course are the barrage of pages, cell phone texts, acute patient care issues and the list goes on. Honestly, I was fine with this pattern because it has been going on since the beginning of my residency years, but now that I have a child….the rules to my crazy game of life have changed.

My baby girl who is now two years old is at this incredible age where every moment is of significance. She’s discovering her mind and the world that she is in. I realized I must focus and ‘be in the moment’ during the limited time that I have with her throughout the day.

So these past few weeks I’ve dived into the field of focusing. Strangely enough, after scouring the Internet and stumbling upon a TED talk about ‘happiness’, one main finding that I thought was intriguing is that the mere lack of focus or shifting of the mind can lead to unhappiness. The other activity that I’ve started are guided daily ten to fifteen minute meditations. It’s helping to drown the noise in my mind, and practice being aware of what is now.

I’m starting to see the effects of some of this and I’d love to hear what the rest of you brilliant moms out there are doing to hone your focus and truly be in the moment.



I'm an academic hospitalist at SFGH/UCSF. I have a 2 year old daughter. You can follow me on twitter @psanyaldey.

Friday, April 1, 2016

Guest post: Why I can’t be Mom and Doctor to my own kids

A few years ago, my eleven year-old came down with something. He felt horrible, and after a long day in the clinic, I dosed him with ibuprofen and tucked him into bed. I reassured him that he would feel better soon. I’ve got this, I thought. I’m a doctor. I wasn’t going to panic about a day of fever and malaise. I pulled out the Gatorade and chicken soup and enforced naps. My quarantine was effective, and no one else got sick.

Four days later, he was still vomiting. He stopped drinking. He had no interest in his favorite ice cream. Soon, he was barely making urine. Kicking myself, I imagined simultaneous appendicitis and rhabdomyolysis, Occam’s razor be damned. Or instead, rashless HSP. My quarantine mocked me: no one else had caught it because it wasn’t contagious. I called my pediatrician and showed up in the office with a child whose moaning broke my heart and accused me of neglect. Had I waited so long his appendix had burst? What good was all my training if I couldn’t even trust my own abdominal exam?

I shared my broad and crazy differential diagnosis with our pediatrician, who gave my son one dose of ondansetron and sent urine, blood and a rapid flu to the lab. While we waited, the magically dissolving tablet did its job, and my son sat up, asking for a drink. When our doctor came back in with the lab results, the patient was begging for apple juice and Dairy Queen. I hung my head in shame. Ready to do an appendectomy for Influenza B, I had become the hysterical mother I routinely saw in my own office.

Once the sting of fear wore off, I realized that while being a mom has made me a better doctor, being a doctor hasn’t necessarily made me a better mother. I have yet to locate the elusive sweet spot between the extremes of doctor and mother. I cannot be objective when it comes to my own children. Which is why I keep my pediatrician on speed dial and a supply of ondansetron in my cupboard.



--Ann Dominguez, mom to four children, writer and Family Practice attending. I have been in community health for 16 years. My novel, The Match, came out in November, and is available on Amazon, iTunes and Kindle.

Monday, February 15, 2016

Guest post: My Valentine

This year both my children have their own Valentines to congratulate. I was eating breakfast at  a hotel when one lady approached and asked to share a Valentine story for her anonymous site. It did not have to be a romantic Valentine. Just anybody who you feel special love for. I immediately thought of one person. My grandmother.

About 40 years ago she was working full time and caring for her elderly parents when she took me in. Initially it was about a better school district and starting me on my first year at school. Then she ended up raising me, giving me the best upbringing ever, guiding me, stressing work habits, taking me to movies, theater, and concerts with her. Her life as a professional and community member will always be what I strive for. She grew up in a village, poor and hungry, in a country where authorities took basic posessions from their citizens for all to share. Her family of 8 children had to give up their only cow to the collective farm.The cow would cry passing their house in the evening on the way from pastures to the collective farm. My grandmother and her siblings would gather at the window to see their beloved cow ("feeder") pass by and would cry silently too. The family was allowed to keep the hens, but they had to give away eggs to the collective farm, so that eggs were a special meal on certain holidays only. My grandmother helped her parents at the farm since age 8. When she complained that she was too small for the labor, her mother would reply, "If you only could pick up one thing from the ground, it would be one less thing for me to pick up." So, grandma kept going. Then World War II came. All the food went to the fighting soldiers. There was so little to eat, many days my grandma's family members had one potato a day per person to eat. Life afte war was desperately poor as well. Nonetheless, my grandmother as a university student exchanged her bread allowance for concert tickets and went hungry to be able to see opera, ballet, and theater performances to educate herself about the higher culture, city life. She ended up running financial affairs of a company employing 16,000 people, exporting goods to 35 different countries. She was always proud of helping people and aiding lowest workers in their hardships and pursuit of better life. Many of her coworkers came to wish her happy 90th birthday last year, it made her so happy they remembered her.

My grandmother was the one who pointed me in medicine direction for a career, advised me on my marriage, came to see my children when they were born, remained my soulmate who I can talk to every day. She tells me her only regret now is she cannot visit her great grandchildren due to age. But she is happy she got to see America, the best country in the world. Turns out visiting America was her dearest dream back then, on the farm. She always wondered why Americans lived better and wanted to see for herself. She did, and she was happy her great grandchildren were growing up here. I will be sure to pass grandma's lessons to them - nothing is impossible if you work hard, help others when you can, what you are is more important than where you are from. I will be forever grateful that I was shaped by such a person as my grandmother. Instead of feeling resentful she embraced life as it was and made the best of it.

Elena

Wednesday, November 18, 2015

Guest post: No longer twenty-two and thankful

This has been a reflective week for me. My two-year old, the fourth and last of our kid posse, ditched the diapers. My husband and I are on the verge of making the decision to repatriate our family to the US after five years of living in South America. And I received my first-ever acceptance to medical school.

It's been a long and non-traditional road. When my husband and I met in organic chemistry many years ago, he had already switched his major to English and I was an enthusiastic pre-medical student. After college he took a job that required him to stay in our alma mater's location. I had a track injury that kept me in school for a fifth year. After my graduation, we decided I would take a deep breath from the hamster wheel of school, athletics, research, thesis, more school, and the insular world of which a 22-year-old college student is the center.

As often happens when one takes the opportunity to step back, my horizons broadened. A Masters degree. Marriage. My first year teaching high school with 153 teenagers. A surprise pregnancy. My mother-in-law with terminal cancer. And I hadn't yet reached my twenty-fifth birthday. Sometimes I felt like taking the deep breath was more like having the wind knocked out of me.

Fast forward a few years. My husband's parents have both passed away. We have four lively, enthusiastic children. Our career paths have been eclectic, and we are considering returning to the States, where we will find ourselves at another life junction.

"What do you want to do?" my husband had asked me a couple years ago.

"Well, the same thing I've wanted to do for a long time. Go to medical school."

He smiled, chuckling at the roundabout trajectory we had taken to get to this point from our chemistry classes way back in the day. "Well, let's go for it and see what happens."

I flew back to the States and took the MCAT seven months pregnant. I asked my thesis advisor if she could dig up the letter of recommendation she wrote for me over a decade ago. I finally filled out the tedious AMCAS application. I went to my first interview wearing a green suit (slate green at least!), and quickly realized that everyone else was wearing black, with a dark navy or two thrown into the group. But I am okay with being non-traditional.

I am no longer twenty-two, and I am thankful. Thankful for the crazy road of life, that has left me with unexpected joys, scars of sorrow, and varicose veins. Thankful for a family that has encouraged me through multiple moves and international transitions with uncertain futures. Thankful for the medical admissions committee members who decided to give me a shot.

And thankful for all the Mothers in Medicine, who have shared their stories and their journeys. Many blessings to you as we finish another year celebrating all the lives with which we are intertwined.

A soon-to-be MS1

Monday, November 16, 2015

Guest post: Unexpected gratitude

I love Raymond Carver's poem "What the Doctor Said." The doctor tells the poet he has widespread metastatic lung cancer. The poem ends with this:

I jumped up and shook hands with this man who'd just given me
Something no one else on earth had ever given me
I may have even thanked him habit being so strong

I may even have thanked him. 

I don't have to tell people they are dying. I'm a hospice doc. My patients know they are dying before they meet me. Everyone knows they are dying. They may not want to say it out loud, and they may use a variety of euphemisms, but everyone knows. I don't have to say it. I do have to find a way to answer the question "How long?" I always start and finish my answer by saying "I don't know." We never know for sure. I am frequently surprised - I am surprised how quickly some people die and how long some others linger. I am surprised by so much about this work. I am surprised by the peace that I feel at the bedsides of the dying, and how comfortable it can be in our inpatient hospice unit. I am surprised at the laughter I find when I make home visits. I am surprised by the capacity of family members to do the hard, dirty, physical work of caring for their loved ones.

And I am surprised when they thank me.

Patients thank me for coming to their homes. "A doctor who makes house calls! In this day and age"! Caregivers thank me for the medication that eases the symptoms and makes their job easier (even though it's the nurse who tells me what they need). Family members thank me for clear explanations of the medical system and for signing forms (although most of that credit should go to the social workers who do all the actual work). All of that makes sense. I have done something, given them something, provided an answer or solved a problem.

Then there's the question no on ever wants to ask: "How much longer, Doc?" It's often asked in the hallway of our inpatient hospice unit. Someone is usually crying. Sometimes the someone is me. I am as honest as I can be when I don't really know. I say "I don't see anything that suggests it will be the next few hours...", but I know the patient might be gone when we walk back into the room. I ask what the family needs - what decisions are they wrestling with? Who needs to come in from out of state? Who are they trying to protect? And at the end of the conversation, they say "Thank you." I am always surprised.

I don't really know why they are thanking me. Perhaps it's for some clarity and honesty after the muddle of modern medical care. Perhaps it's for the moment of connection and the respect I hope I'm communicating. And perhaps it's what Raymond Carver wrote about - that I have given them something no one else ever has.

Those moments will continue to confound and humble and amaze me, and for that, I am thankful.


Jay is an internist working full-time in hospice and palliative care and mom to a 15-year-old daughter.

Tuesday, August 18, 2015

Guest post: How hard things can get

I am a more than full-time family doctor. I manage my own office and do extra urgent care shifts on weeknights and weekends. I have a very busy, demanding and wonderful two year old son. I am paying off my mortgage and helping my husband get started with a farming business. I am struggling to keep up all my medical skills, applying for continuing education grants and trying to stay healthy and balanced...

I thought my life was chaotic enough... then...

I find myself pregnant with my second baby. 8 months of a very difficult pregnancy follow, forcing me to eliminate night and extra shifts. I don't sleep and suffer from severe heartburn later found to be due to polyhydramnios.

My baby is born a month early and at 24 hours, I find out he has a major birth defect, undiagnosed through the pregnancy, an extra connection between his trachea and esophagus with no connection to his stomach.

I am discharged in the middle of the night, sleep deprived for 48 hours and severely anemic with my son to a children's hospital. I have to drive myself, and it is heartbreaking to leave the hospital with your flowers and gifts but not your newborn baby after giving birth.

We survive intubation, days on a ventilator, swelling, emergency surgery, jaundice, phototherapy, catheters, central lines, ng tubes, countless needles and tests to look for other problems. He still can't swallow and is aspirating. At a family meeting I learn his vocal cord was paralyzed at some point during all his testing and procedures. It should heal but over weeks or months. Otherwise he may need a gastrostomy tube for the next year.

As I drive in daily to visit him in the NICU, nearing his 1 month birthday, I cry. I blame myself even though his doctors tell me it is not known why this defect happens. I blame a sinus infection, not enough nutrition, exposure to farm pesticides I might have had on a hike...the list goes on. I can't let it go.

I sit in the NICU and hold him, wondering what the future holds. Nobody can predict how things will progress with him. All we can do is take it day by day, waiting to see if he stops aspirating and starts swallowing on his own- then his TPN and NG tube can be removed.

As I sit in the NICU, every little thing scares me- an increased heart rate, no weight gain, a rise in temperature, I usually get so worked up within an hour that I have to leave and let my husband sit with him. Normally I am calm in this environment, but that is with other babies, not my own.

And the stress of the situation is affecting everyone around me. My office staff don't know how to book my office, when day by day, I need to be in the NICU and I don't know how long it will last. One staff is billing me for hours she hasn't been at work, another is demanding a raise (could she have picked a worse time)?

My husband is snapping at me for asking questions and his parents are telling him to give up on his farming business for now to devote himself to the care of his two sons. I am the breadwinner for the family, so if we need to bring home a high-needs baby, he needs to be the one to give up work opportunities for now. I feel guilty about this too.

My intent had been to have the baby and return to work the next week, as I had done with my first. I never thought to make a plan B. So I post ads for a locum and a babysitter for my older son, but as of now, no replies to either. And my patients don't understand why the office is closed down-they just want their doctor back.

I look back to all the times I thought I had so much stress in my life, school and residency especially, and they don't compare to this.

Today the first good news in a long time came. I have won two awards for continuing medical education courses. I will also have a chance to work as a locum in a place that I have wanted to work for a long time. This hint at my past organized life as an FP is so reassuring when the rest of my life is so chaotic and the future so uncertain.

I tell myself to focus on the positive and not worry about what can't be changed. This is what I have told past patients and this is what I do. I am learning a lot just sitting with my son in the NICU. I am donating milk to other babies. I am spending more time with family. I am learning empathy and how it feels to be a patient's mom. I have some of the best night-time babysitters around- the NICU nurses. Most of all, I know that in another time or place, my son would have died from this now corrected birth defect.

If this is how hard things can get, I hope that eventually things will swing back just as far in the other direction. Once they do, I will have to write again.

Thursday, July 16, 2015

Guest post: Miscarriage

I thought I was over my miscarriage, but I’m not. It started when I wishfully wasted a home pregnancy test a few days ago (negative.) This past weekend I’ve been taking the Advanced Life Support in Obstetrics course, delivering rubber babies with shoulder dystocia and fighting back tears the whole way.

Let me start from the beginning. I’m 35 and just starting a family medicine residency. I’m newly married to a wonderful man; he will be joining me when he finds a job in the far away city where I moved for residency. I found out I was pregnant in May. It was my first pregnancy and we were overjoyed.

One month ago, I had my first prenatal visit at an OB/GYN practice in my new city. I went alone. I wore my favorite blue dress. I was happy and confident and looking forward to taking home images of my 8-week future baby.

The appointment started with an ultrasound. I wasn’t alarmed when Monica, the sonographer, asked to switch from a transabdominal to transvaginal view. No problem, I thought. When the imaging resumed, I asked Monica if she could calculate my due date. She paused for a second, and then said, “Well, I’m seeing some concerning things here.” The floodgates opened and I started crying. In the nicest way possible, Monica described the enlarged yolk sac and absent heartbeat. The embryo had died ten days earlier.

Through my tears I met the nurse practitioner who explained my options: since I was starting residency in just over a week, I chose surgery. I spoke with the physician, who booked my D&E the following day. Everyone asked me: where is your husband? (Florida.) Do you know anyone here? (No.) Who will be with you for the surgery? (I don’t know.)

OB/GYN offices are filled with pregnant women and their spouses, best friends, mothers and sisters. It hit me hard when I waited alone for my pre-op bloodwork, then for my Rhogam shot, surrounded by women who still had their babies. I felt their eyes on me, felt their pity. An hour earlier, I too had been smugly pregnant, thinking how elated my parents would be when I told them about their first grandchild.

My husband flew in the same day (I have never asked him how much his flight cost.) The D&E was uneventful; I had no pain after the surgery. We went out for steak that night; I had red wine and blue cheese, because I could. Because I was not pregnant anymore.

The past month has been a whirlwind of excitement, of new long white coats and responsibilities and stresses. Amongst the distractions, I haven’t grieved. But I remember something my physician said before the surgery. She said: “Miscarriages are very common. They’re the norm. But in our society, we don’t talk about them. I wish women talked about their experiences with miscarriage instead of grieving in secret.” And so that’s what I’m doing here. I want to tell you that I’m sad, that I’m angry, and that I’m not okay with what happened. I hope it helps me move on.

Monday, April 27, 2015

Guest post: Gender equality?

I generally LOVE my job. I work part time as an anesthesiologist at an academic medical center in the Midwest. There are several other part-time faculty in my department, both male and female, which has created an atmosphere where the commitment of part-time workers to their careers is not typically questioned. My department recently scheduled an all day seminar on an upcoming Saturday, geared for and limited to our own department's clinical faculty, with educational topics ranging from reviews of clinical care, giving feedback to residents, and research resources. I decide not to go, as Saturdays that I'm not on call (I'm typically on call one weekend/month) are generally reserved for family time, my kids have some new activities starting this Saturday, the weather is (finally) getting nice, and with the exception of about a 2 hour period, I'm not that interested in the agenda. So I have a discussion with my husband (who is generally wonderful and supportive of my career) about our upcoming weekend plans and I mention that I may go to the 2 hr period of the seminar that I'm actually interested in, depending on what else he has planned/would like to do with the family. It turns out he is not at all in favor of me going to only the 2 hours of interest to me- he thinks I'm making a big mistake by not going to the entire seminar- commenting that I will likely miss out on networking opportunities, face time with higher leadership, etc. The discussion continues, and he comments, "3 out of the 4 women who directly report to me behave just as you're doing, not taking after work hours events seriously...and it is negatively impacting their opportunities for advancement." Side note: he works as an upper-level manager at a major business and typically spends at least 2 evenings/week out of the house attending either work related activities or board of director activities for local non-profits. At this point, I was pretty angry, reminding him that the 3 women in question all have young children (as do we), and I ended the conversation telling him, don't take it for granted that you are able to spend multiple nights/week away from home for various purposes- it's only because I am at home caring for the family that you get this opportunity- these women that you work with that don't make it to all the evening activities- who is caring for their families?- that's why they're not there.

As one may surmise, working at an academic center means that there are frequently lectures, town halls, discussions, seminars, etc to which faculty are invited to attend. Once in a while these sound interesting to me and actually don't conflict with my clinical responsibilities. However, I usually feel stressed when I decide to go as it means either arranging evening childcare or childcare on what would normally be my day off with our nanny (she is great and very flexible but out of respect for her I do my best to minimize requests for super early mornings, evenings, and significant schedule changes to what is truly necessary) or trying to explain the importance of it to my husband so that he will be home at a reasonable time (it is not uncommon that his evening activities come with only a day or two of warning). In the end, I usually just don't go- it's much easier that way. I am long past the "Mommy guilt" that I felt for working at all when my first child was born; I truly love what I do, am proud of my work, feel reasonably respected at work, and feel like I honestly do have a good work-life balance. I am able to make some time for myself without guilt- I go to the gym semi-regularly and spend time with girlfriends about once/month. However, I admit I continue to struggle with guilt in situations such as the one I mentioned.

So, I'm interested in the opinions of others- how much should our attendance be expected at after hours work activities? How much guilt do you feel about going (or not going) to these types of events? Do you even feel like you really have a choice to go given family responsibilities? If you regularly go to these types of events, how do you manage to get there?

Tuesday, April 14, 2015

Guest post: Oral boards anxiety


Tonight I ran a Google search "thoughts about the oral OB-GYN boards" and your site came up. I read all your comments in the hope I will find some relief of my anxiety. I did not.

You see, I passed my oral OB-GYN boards 6 years ago. I can't remember being this petrified prior to taking them and I felt ok after the examination has ended. Now, it's time for round two: my oral subspecialty Boards. I can't figure out why, but this time around I am mortified. Everything about it, the clinical part - am I thinking like a subspecialist? am I dissecting this disorder process in 10 different way for analysis? The research part (the scariest of all) - am I going to survive the probing questions regarding the study design and power, the statistical significance of my results, is my data "worthy" and my results "meaningful" to their scientific expectations? An then, the genetics - will I remember what findings fit the puzzle of what disorder, how well am I counseling my patients? I wish I could find my answers before I walk into that room to go through it all for yet again, the second longest three hours of my life.

I hope I will survive them next week and not have to repeat this ever. Although I am as prepared for it as much as I will ever be, I still feel "On a wing and a prayer."

Speaking about a prayer, I think I could use one in just a few short days.



A little bio about me:
IronGirl practices Maternal-Fetal Medicine in Midtown America, mother of two beautiful children Jek 13, and Lui 10, wife to Mr. Bold, non-MD guy that likes to play with fire and ice for a living, awesome hubby, caring partner, and multitasked oriented sports-dad.

IronGirl likes to spend her free time (is there any time that's free, hmm...) running, biking, swimming, racing, and sometimes just chilling by a bonfire listening to Flamenco music. And now, getting initiated into blogging.

Monday, April 13, 2015

Guest post: ADHD or ASD?

My oldest child is eight years old. He is funny, super-smart, and charming. He once made up a song about how much he loves me.

He has also recently been diagnosed with ADHD.

You see, ever since he was very young, I knew there was something different about him. I was just finishing my second year of medical school, and he was my first child. But I knew. In infancy, he stared at objects of interest with an intensity of focus that was mesmerizing. When he began to speak, he spoke eloquently (seriously!) and argued his points with logic well before the age of 2. He never joined in group activities, but observed them solemnly and seriously. He slept poorly. He had explosive, long-lasting, inconsolable tantrums about everything from transitions to meals to seams in his socks. He had severe separation anxiety at school drop-off, which lasts to this day. He had (has) exquisite sensory sensitivities. He remains a slave to routine and ritual (and reacts poorly indeed when things change). He can talk for hours about black holes and superheroes. He clearly loves his siblings and his parents, but all interactions must be on his terms.

I thought – I still think – that he has an ASD. Asperger's. It's him to a T.

I could write for pages and pages about my son and his symptoms and his birth and neonatal course and December birthday and GI problems and build my case to you – fellow physicians and mothers – as to why I am so sure that ADHD is the wrong diagnosis. But at the end of the day, in my mind, the letters don't really matter. All I want is someone out there to help us better parent our child. The way he relates with the world is not "neurotypical", that is for certain. But how can I help him, who he is, grow and thrive and make his way in peace and confidence in this world? My husband and I have done a lot which I think has been very good for our son. But we were at an impasse. We took him to the pediatrician because we were looking for help. Guidance.

So now we have this diagnosis. Maybe it is accurate, maybe not. I am truly not writing this as an argument one way or another for his actual diagnosis. The essence of my post relates to my own reaction to hearing the diagnosis. I just thought: no. Not that. NO. I would have accepted "ASD" – I suspected it. I may have accepted some kind of anxiety disorder. Or – no diagnosis! That's just who he is, and here's how we can help you. That would have worked. But ADHD… I absolutely balked. Why?

I feel that in popular media, ASD is portrayed as a diagnosis which is blameless. Autism support groups, parent groups, blogs, articles, and fundraising abound. There are supports for parents, and children can receive evidence-based treatment (at least in my province). We have specific screening tools in Ontario, for use at the 18 month well child visit, specifically to screen for ASD. And don't get me wrong – rightfully so. Early intervention works and should be promoted. Also, I'm NOT saying parents of children with ASD have it easy. Not at all.

Now I contrast with ADHD. I feel that ADHD is portrayed more as blame-able (i.e. on the parents) and less "real." ADHD is often the butt of jokes or widely derided as an "excuse" for poor behaviour. I do not know of any screening for ADHD that is done in routine well-child visits. I do not see articles or blogs about parenting a child with ADHD. I don't hear about ADHD research fundraising activities. I'm not saying they don't exist. But I do not think that they are as "out there" in popular media.

I am not a pediatrician, nor a psychiatrist, but I understand that both ASD and ADHD are considered neurodevelopmental disorders which arise through an interplay between genetics and "environment" (that lovely catchall for everything from prenatal exposure to substance X to pollutants to diet and so on). I do not think the medical community considers one or the other of these diagnoses to be the parents "fault." But I do think, that deep down (and I am ashamed to say this), I am afraid of my son being diagnosed with ADHD. Afraid of the looks. The blame. The rolled eyes. The label. Afraid of the consequences of starting him on medication – or not doing so. Afraid of possible misdiagnosis and its consequences. Afraid of grandparents finding out and having to deal with the inevitable questioning and doubt. Afraid that I will feel less sympathetic, more frustrated, less supported, more alone. Simply afraid.

I know that my child is who he is, despite any diagnosis or lack thereof. I know that one diagnosis is not "better" than any other. Diagnosis won't change who he is. I want to be clear that I am not saying I want or favour a certain diagnosis for my child. Nor am I implying any judgement of any of your children with these diagnoses, or you! Rather, I write to explore my own reaction to this situation, and to consider the reasons behind it, even though in doing so, I seem to have uncovered my own fears and biases.

What do you think of when you meet a child with ADHD? The child might be a patient, a niece or nephew, a classmate or friend of your child. How does that differ from your feelings when you meet a child with ASD? Are you more or less sympathetic? Understanding? Willing to forgive / accept / work with the child's behaviours?

I want to parent my child as best as I can. I want what we all want – I want him to feel loved, confident, and secure. I want him to thrive. I know that the letters won't change who he is. Despite my fears, I also know that the letters won't change who I see, as his mother: a very unique and special child with some incredible talents and some special challenges to work with. The question is: will the letters change what others see?

Wednesday, February 4, 2015

Guest post: Trust me, I am a mother

I never went into medicine to become a better mother. I never became a mother to become a better doctor. But, the two journeys merged in 2013 when I knew something was seriously wrong with my almost six year-old son. My son is like any other boy his age, other than occasional mild irritability that is slightly over the average and incredible creativity. He usually springs out of bed ready to tackle the day, excited about all the projects he is going to do. For about ten days, I noticed that not only was he not interested in any activities, but he was incredibly irritable at even the most minor setbacks. He has always had a high pain threshold, yet we started noticing an increase in his frequency of "got hurt" episodes. There were no focal deficits on physical exam. I sent an email to his teacher asking if she noticed any limitations at school. She said no. I didn't know if I should go to a pediatrician or a psychologist. Then, he developed a minor unprovoked pain in the shin. I jumped on it as now I had a reason to take him to the pediatrician. I reasoned with the pediatrician that given the irritability and mild low grade temps at night time for two days, his shin pain may have been an indicator of something systemic. After an exam, she ordered some blood work and X-rays which came back normal, other than a slightly elevated WBC and platelet count. She told me to trend the fevers and to come back if there was no improvement.

The same night, I noticed a slight temperature and called the on-call doctor. I explained that I was concerned about the low grade temperatures without an obvious source, and that the shin pain might point to a musculoskeletal or neurological issue. She also told us to "trend" the fevers and call her back in the morning. Completed unreassured, we took him to the emergency room. A full day waiting in the emergency room led us again to blood tests that were mildly abnormal but not convincing for any diagnosis. An MRI of the leg was done which was read as normal. I pulled the pediatric ER physician aside and told her my concerns: was there something systemic? As an adult critical care physician, I was not the kind of parent to seek attention unless I was truly concerned. I alerted her that I was concerned regarding the elevated white count and thrombocytosis without an obvious source and even more concerned that the MRI was normal. We were told to "trend" the fever, and if it became more than 101.5, to seek attention. We were also to give scheduled ibuprofen to suppress any synovial inflammation that may be happening in the hip from a viral infection two weeks before. After a dose of ibuprofen, they tested his walking, and said that it was noticeably better, so it must be Transient Synovitis, a diagnosis of exclusion. One caveat to this "give the drug, and see if this gets better, if then, it must be this" argument is that it is absolutely flawed. If the participant knows that "he or she is supposed to get better" then the free will overcomes any pain and of course, he is going to walk better. It may or may not have anything to do with the drug. We walked out of the Emergency Room still concerned.

I continued to give him ibuprofen over the next day. He continued to limp. The ibuprofen suppressed the fever, so now we had an afebrile child who couldn't walk. After no significant improvement, we took him back to the pediatrician office the next day and asked for a neurological exam and, bingo, over the course of a few hours my child developed cerebellar ataxia, clonus, and inability to stand. All of this happened within the time we saw the pediatrician, got him back to the emergency room, and a MRI was scheduled. That night as I sat at the edge of the MRI machine holding his leg, I had never been more frustrated with the fragility of the human body. I loathed hospitals. I never wanted to step foot in the hospital again. The doctor inside of me put the differential diagnosis of "epidural abscess, brain tumor, meningitis, encephalitis" on the list, while the mother inside of me put "something really bad" at the top. While the initial scout films started coming up, my husband, who is a body radiologist subspecialized in MRI, stood by the MRI technician with a solemn look in his eyes  -- one that I had never seen before. As he drew his finger in a vertical line across the computer monitor, the heart of the mother inside of me sank, while the doctor inside of me said, "Wait, that could mean it is not a focal tumor or an epidural abscess, but could it be a diffuse tumor? Maybe, it is meningitis."  With one hand on my child's leg amid the deafening noise from the machine, I kept waving to my husband to see if he could tell me something. He asked me to come outside and knowing my child was already asleep in the machine, I stepped out and could immediately notice the flair abnormality that swept across the spinal cord. As the axial cuts were pouring in, we could see the flair signal lit up like two snake eyes pointing to the diagnosis of Transverse Myelitis, which we knew only held very good prognosis one third of the time. There was no Brain MRI ordered as the ER staff wanted to "focus on one thing at a time," and it  seemed that the spine was the problem. Thankfully, the neuroradiologist who was examining the scout images, and who was about to leave in thirty minutes for the night, noticed the transverse myelitis throughout the spinal cord and asked the technician to add a brain MRI. Within minutes we found her and discussed with her and confirmed the diagnosis of Acute Disseminated Myeloencephalitis with Transverse Myelitis, a disease that occurs in my child's age group, typically after a viral infection or a vaccine.

During the hours in the emergency room, my son went from being able to walk with a limp to being unable to move both legs and becoming tachypneic. Prior to returning to the emergency room from the MRI, I told my husband that knowing the diagnosis, they will for sure want to do a lumbar puncture to rule out active bacterial/viral meningitis and this will of course delay steroid treatment if the lumbar puncture was not done in an expedited manner. We were already in the emergency room for twelve hours by the end of the MRI and given the progressive course of his symptoms, further delay could have caused him to progress into a coma and the risk of hemorrhagic encephalitis existed. Upon return, we asked the team to be present at his bedside, and we made our concerns open to them. The on-call ER physicians were skillful and quickly performed the lumbar puncture. We soon knew that there were no alterations in protein/glucose/gram stain and that we had the right diagnosis. The ER team hung the bag of 600mg of IV solumedrol before we were transferred up to the ICU and every successive day resulted in more return of neurological function. Within five days, we were at home recuperating after this nightmare of an illness. The neurologists repeatedly told us that they have never seen a child with such degree of MRI severity not have the physical signs to reflect the changes; it is likely because we sought attention right in time. The mother inside of me was strong during the five days, and the doctor inside of me was quick to decline any unnecessary blood draws and made sure that he got out that hospital as quickly as possible. For if anyone knows how deadly hospitals can be, it was the doctor inside of me. We were welcomed at home by a supportive community and his return to school and activities was a breeze because of the love and support from family and friends. When I bought my son a couple of youth basketballs to help his recuperation phase, he jumped out of the sofa, ran to me, gave me a big hug and said, "Mommy, how do you know me so well?"

I said, "Trust me, I am a mother."

Wednesday, January 21, 2015

Guest post: Fewer patients, more friends

On the face of it, a day at the clinic seems very social. I see patients, one after the other, from nine until four, with a break for lunch. Most of my patients I've known for a while now. I get caught up on their their lives - school, family, work. "How are your spirits these days?" I ask almost every time, patting my right hand over my heart, using the most effective cross-cultural mood elicitor I know.  It doesn't get much more personal than this. It's just me and the patient, our knees almost touching, in a small exam room with the door closed and an interpreter behind my left shoulder.

I leave work after a day of this, drive the five minutes to pick up my three-year-old from preschool, and begin the commute home to Deep Cove. Suddenly I'm ravenous. I ask Ilia what's left in her lunch box and she hands me some carrot sticks and cubes of cheddar from the back seat. Ten minutes later, around Grandview and Nanaimo, I bottom out, utterly exhausted. The idea of having to shepherd four kids through meal time and bedtime chores after this feels impossible.

If Pete's not away on business, I come home to sous-vide salmon and curried cauliflower, and we divide up the after-dinner work. If he's traveling, we eat the lasagna my thirteen-year-old put in the oven when the big kids came home from school. Then I oversee homework and lunch making, brushing teeth and laying out tomorrow's school uniforms.

I cut corners. I pick the bedtime book with one sentence per page. I move up the bedtimes of the kids too young to notice. I want the noise to stop, even the singing. They're getting shortchanged, I think, but  I'll make it up to them later in the week.

Where I live. And why I live here. © Martina Scholtens. Deep Cove, BC
For years, I've seen patients Monday, Tuesday and Friday. Mid-week I'm home with my youngest, grateful that Deep Cove is off the beaten path. We can't see our neighbours from our place. Looking up from the laptop now, I see a stand of waving cedars, the gunmetal grey winter waters of Indian Arm, and the dark bulk of Belcarra rising from the opposite shore. The solitude is perfect. No play dates, thanks. No community centres or meeting up for lunch, either. I might be up for something on the weekend, but it'll take until Saturday evening to recover from Friday's walk-in clinic.  I need a respite from human contact, and I prefer as much solitary time outside the clinic as four kids will give me.

I forget, though, that seeing patients isn't at all a substitute for catching up with friends over drinks.  At the clinic, the topics of conversation, the confidences, the complaints - they're all one-sided. It often strikes me that family physicians are professional friends: non-judgmental, accessible, reliable, skilled listeners and excellent secret-keepers. There's pleasure in seeing patients, but really, it's business.

If you had told me that I'd have four kids and eight hundred patients, and feel lonely, I'd never have believed you. But my work drains me to the point that all of my spare time is spent trying to recuperate. Pete would love to have people over more, and vacation with other families. I always imagined a noisy, boisterous home with friends and family coming and going, but with my work commitments, I don't have the psychological reserves to make it happen.

Then I had an epiphany. Clinical work exhausts me with the people lineup, and my social life is extremely thin because I need stretches of alone time to recharge from work. I ought to reverse this. I need to implement more solitary time at work, and more people-time in after hours.

I've started on this. In October I gave up my Friday clinic. I've worked Fridays since I finished residency in 2003. Now I finish the week with administrative work and other projects instead, alone in my organization's secret library. Just me, a row of computers with access to our clinic's EMR, shelves of journals on paediatric nutrition, and a yellowing poster on Boolean operators. I can do this very happily for much of the day, and still have the energy to go out with Pete at night. It's been life changing.

I knew from residency that I couldn't see forty patients a day, five days a week. I find it hard to do half that. Maybe it's that my patient demographic, refugees with trauma histories and multiple barriers to care, are particularly challenging. Or maybe it's the demands of four kids. Maybe our clinic needs to use a different model of care. Maybe an office with some natural light and a view of the North Shore Mountains would help. There are probably other changes I could make to bolster my psychological fortitude and soldier on, even thrive, in this setting. But for now, I've reduced my work hours devoted to direct patient care.

Three months in, and no regrets. Before, I felt like I spent everything at the office. Now I've got this feeling of having a bit of pocket money. There's the promising jingle of spare change.


-Martina Scholtens, cross-posted at www.freshmd.com

Monday, January 19, 2015

Guest post: Loneliness

Cross country move to start a second residency, otherwise known as a long fellowship. Getting pregnant in residency. Health issues in the family. Yearly in-service exams. Patient care. Having a baby. Board certification for the first residency. Learning curve. Conference presentations. And now there is job search. I get by in most of these situations. I must say I have excellent family support, but a physician spouse can also only help so much. I find myself exhausted, sometimes nervous, mostly looking forward to the days going to work and coming home. But I also find myself extremely lonely. There is no time or energy to go meet other mommies. No time to hang out with your single or non-parent colleagues. (They don’t invite you anyway) No time to form new friendships. Hardly some time to hang on to the old ones you have left behind in another city and another country. I love my husband, who is also a hus-friend! But, a girl needs some girl friends.

I find myself making awkward attempts at trying to set up playdates with other moms, who apparently have their baby’s social life all dialed in.

Do any of you other mothers in medicine experience this loneliness? Or is it just me? Should I even allow myself to feel lonely when I have a lovely child and husband. Can you be busy and lonely?

Thursday, November 13, 2014

Guest post: United we stand, divided we fall

Editor's note: MiM contributor juliaink came across this blog post and thought it would make a good guest post here. The author was gracious in sharing it with us.


I was going to write about how new parents need to come together to create a “united front” when it comes to how they’re going to raise their baby, but because of a great thread I’m following on Facebook, my focus is beginning to soften and is more inclusive. There is a need for new parents to really hash out all the key points on how you intend to raise your children – before the baby arrives. If there are any big differences in your parenting styles, it would be best to know before your little person comes into the world to shine a spotlight on them! And if there are challenges between the generations, and there almost always are, it’s important for the couple to unite together for the sake of their own relationship. If a particular issue with a grandparent comes up, their child should speak directly to them about it – not the in-law child. This is just basic information that you’ve probably already figured out as a couple, but has special importance when you become new parents.

Having acknowledged all of this, the thread I’m following on Facebook talks about how grandmothers might experience postpartum mood disorders as their own daughters become pregnant and give birth. This was nothing I’d ever considered before, but makes complete sense to me upon hearing it. What a woman experiences during her birth will remain with her for always, her whole life. As a woman’s own daughter begins her journey toward motherhood these emotions and feelings from so long ago might begin to resurface. This can cause strain in the mother/daughter relationship as the soon-to-be grandmother revisits her own experience. If it was negative or traumatic for her, than there will be challenges that come along with this remembered event. If there were no real issues at her birth, there can still be some challenges or feelings of judgement if her daughter decides to do things differently from the way she did in her early years of mothering.

The same can be said for fathers and grandfathers. We live in a very different time with new research and lots of ideas about best practices during pregnancy, birth and parenting that just simply did not exist when our own mothers and fathers were on their journey. It’s no wonder that we have plenty of families having discussions with soundbites like this:

“When we were having babies, we just did it! What are you so worried about?”

“Well, that’s not the way we did it when you were a baby, and you turned out just fine, didn’t you?”

The health care system I work for has a fairly new class called “Grandparents Today” and it’s geared toward softening these conversations between the generations. It’s taught by a retired L&D nurse of 35 years on the floor who also happens to be a grandmother herself, so this is peer-to-peer education. The class brings to light all of the current information we have on how to keep babies safe when sleeping, why there is such an emphasis on breastfeeding, how and why it makes such good sense to wear your babies and have them skin-to-skin as much as possible, etc. The grandparents who take this class absolutely love it! They come back to their own children and school them about these best practices and everyone lands on the same page – at least about the things that are taught in the class.

I’d like to propose these two generations take this opportunity of bringing the newest family member on board as a chance to unite the whole family around raising this little person to adulthood. It’s a ton of work to do this job well – if you’re lucky enough to have your parents nearby and can count on them to assist with the day-to-day care of your newborn, this can be a lifesaver for you and your relationship. But even if they’re far away, relying on the wisdom that they possess – just from having more years on this earth than you – can be so helpful.

When talking with them about your challenges, try hard not to compare your situation to theirs. Yes, you might be going back to work full-time and they stayed home, but every parent works – just in different locations! Include your father in this new stage of his life without resentment – it was a different time and he was not encouraged to take part in parenting the same way you are today. If your mother never breastfed you, remember that as she’s learning right along with you, her words don’t mean to be unsupportive, she just might be feeling a little guilty about not doing this when it was her turn.

Having a new baby means stretching, growing and making room for this little person. Everyone examines who they are in relationship to this new life and it brings up stuff for each member of the family, some of it good and some of it not so good. Don’t assume anything in communication with one another. If the words you hear sting, instead of getting defensive, pause and try to imagine where their hurt might be coming from. Ask lots of questions. Look for understanding and common ground.

Having a baby does not have to be something that divides a family – it can be something that brings you all together. Being aware of these multi-generational challenges can be one way that you get closer to your own parents. Isn’t that something worth fighting for?

When you had your baby, did issues arise between you and your own parents? How did you handle them? Did the baby bring you closer together or drive you farther apart?


-Barb Buckner Suárez, a childbirth educator
Originally posted at Birth Happens

Wednesday, October 29, 2014

Guest post: It takes a village . . .

...and my village includes a housecleaner, a nanny, a back-up part-time nanny for on-call days, an amazingly flexible husband who works from home and one amazing non-medical friend I've made in this new city. Plus, in really important crunch times, a family willing to fly across the country for weeks at a time to care for my family so I can focus on studying. I come from a family whose resources definitely did not allow for hiring nannies or housecleaners, so I always feel a little self-conscious about it and hesitate to seek help, even when I know it’s needed.

Before medical school, and even during the first two years, I could usually balance the work of school with the work of home. Between studying for Step 1 and then starting 3rd year, with two young children, I realized something had to give! I finally accepted the fact that extra help was necessary, for my sanity and for my success in medicine. While I don't mind cleaning the tub or mopping the floor, I would rather spend that time playing with my children, hanging out with my husband, trying to maintain some relationship with my friends and family, and of course, reading, reading, reading for school!

Since I've relinquished control of keeping up with the cleaning, and since my husband has taken over the cooking (mostly), I'm amazed how much time and mental energy I've been able to devote to school. I'm also pleasantly surprised at how much this extra time to study has boosted my confidence on the wards and subsequently my performance. Meanwhile, at home, I'm actually more likely to tidy up and clean a bit every day, since I don't feel so overwhelmed with the amount of cleaning to be done. This makes my husband, a neat freak by nature, extremely happy. Historically, every woman who could afford to hired people to help manage the house, so why do we try to be superwomen today?

I'm interested to hear how other mothers in medicine have found ways to expand their village of support and if they noticed a difference in their professional lives. I’m also interested to hear if you received any negative responses from your family about hiring help?

Ley is a medical student with two children under age 5. She lives on the west coast and remembers enjoying running, cycling and camping before medical school happened; she hopes to return to those hobbies sometime in the next decade.

Friday, October 10, 2014

Guest post: Taking a year off before medical school

I found MiM while studying abroad, trying to decide between PA and medical school, and being thoroughly terrified of not being able to spend time with my future family if I became a doctor. Reading all of these amazing stories from mother doctors helped erase my fears. I just wanted to give back to the blog, if possible. Also, I thought there might be some other undergraduates out there who can relate. So, here are some recent thoughts:

Had anyone asked me three short years ago what I would be doing after graduation, I would have immediately replied, "going to medical school." After three long, but fun and enriching years at a small liberal arts college known for it's rigorous science reputation, I'm ready for a break.

How did I get from that young, enthusiastic 18-year-old to a 21-year-old who self-professes her exhaustion from school? How did I decide that I am probably going to delay motherhood for an entire year, since I'm planning on waiting to have a family until post-residency? (that was a pretty large factor in my thought process) No, I didn't have a horrible college experience. I didn't have to retake classes, or even get "lost" along the way. Honestly, I just grew up. Needing a break isn't something I'm ashamed of. In fact, as my aunt said, it's probably one of the smartest things someone looking at graduate/professional school can do. I realized I'll have one year in my 20s not in school-- whether I take a year off or not, so why not make it now? A year off will grant me the opportunity after 18 years of education to stop stuffing equations and facts into my brain and fit in some life experiences to look back on and utilize. I will be able to start medical school refreshed and ready to learn, not just going through the motions to add "MD" to my name.

So many people reply, "Oh," when I say I'm taking a year off. I practically have to convince them that I'm genuinely excited to have time to experience more of the world. I believe it's perfectly acceptable to do whatever is right for you, whether that's powering through, or taking a break! However, I think some people need to realize that we don't always need to be in such a rush to get done with something to move on to the next phase. Slow down and enjoy today because tomorrow may be completely different.


From a "traditional" college senior at a small liberal arts university in the Midwest who plans to become a pediatrician.