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

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. 

Friday, September 19, 2014

Guest post: What's your plus one?

I love the honesty of Mothers in Medicine. I feel compassion for women stretched so thin between two callings. But I’ve got to ask you this: is there more to your life than motherhood and medicine?

I know, I know. For a lot of years, it’s about sleep and survival. But at some point, you’ve got to do you, right? You’re more than a stethoscope, a uterus, and a pair of lactating breasts.

Maybe I’m not saying this right. I definitely don’t mean to act smug. But I know I always wanted to write. I just didn’t want to starve to death, and I liked helping people, so…boom. Medicine. I studied my little heart out. I loved it. Until I lost the residency match, and I had to decide, am I going to keep chasing that ever-elusive subspecialty dream as hard as I can? Or can I do emergency medicine, see my husband sometimes, start a family, and pick up my pen and write again? I chose the second one. Either road would have been fine, but I’ve built a happy life with my childhood sweetheart and two kids, I’m writing, and I want to tell you not to forget yourself, that secret self that doesn’t necessarily earn money or praise or nurture others, it just is.

Medical-wise, I’ve got privileges at four different hospitals now, and one chief of emerg told me, “No. You can’t do it. You can’t work at four different hospitals. It will kill you.” He also limits his staff’s total number of shifts because he doesn’t want them to burn out. Autocratic? Sure. But he’s the only one I know who treats other physicians like human beings instead of widgets who have to see patients faster and more cheaply every day and night and night and day. We’ve been talking about how not to lose yourself, not become suicidal, not treat each other like garbage. Thinking about yourself as an individual and not just a service—I’d say that’s the first step. Plus, I thought it would be fun to talk about our secret selves.


Melissa (aka ACLS)
Emergency doctor/writer, mother of an 8 y.o. boy and 3 y.o. girl, in Canada
http://www.melissayuaninnes.com/blog

Thursday, August 21, 2014

Guest post: Doctor guilt

I have been a faithful reader since sometime in med school (6 years ago?) and have so appreciated all of your posts! I haven't found a community anywhere else with as many talented, empathetic, articulate and amazing women. I'm a family practice doc in a rural town practicing full spectrum family medicine. I have been in practice for two years since residency and absolutely love my job, even when it is stressful and hectic. I am a wife to an underemployed lawyer and mom to a beautiful, sweet, developmentally delayed 11 month old girl with tuberous sclerosis. She is the joy of our lives.

Having worked my whole life, I was really looking forward to maternity leave. I thought, finally, time for a break! As any mom knows, maternity leave isn't any kind of a vacation, but it really was a much needed mental and physical break from work. However, it was also disorienting to not have a schedule and frequent social interaction. I absolutely loved maternity leave and I think part of what kept me sane was knowing that I was going back to work. When the time came closer, people warned me about how hard it would be, and that I was going to cry my first day back.

I shed a few tears the day before, but the day I went back to work I was 100% ok. I enjoyed it, actually. I felt like I was back at my second home with my second family. The first night back I assisted with a crash c-section and had a blast.

It's been 8 months and I'm still going strong. I work in clinic on Monday, Wednesday, and Friday. I do 4 to 5 24 hour ER shifts per month. I am there nearly every day rounding on patients, since I almost always have a patient in the hospital. In reality I probably average 40 hours per week even though I'm considered "part time." I love having every other day off. After a crazy clinic day it is nice to have the next day to decompress. After having a day of playing with my daughter and being at home I look forward to the fast paced environment of being at work the next day.

Strangely enough, I never experienced the mommy guilt that is so prevalent among working moms of every profession. I love both of my jobs. I know my daughter is in good hands. (My husband is with her most of the time when I'm at work, and we have a wonderful neighbor who helps). I miss her when I'm working a 24 hour shift but that's not the same thing as feeling guilty that I'm not there. I don't know if it's because I'm the primary breadwinner or some other reason. I am 100% at peace with my decision to work. How many men who are breadwinners feel daddy guilt? Is mommy guilt something that is part of our genetic makeup or something that we are told culturally we are supposed to experience?

What I have felt sometimes is doctor guilt. I think part of this is because I was 32 when I gave birth so working is what I've known my whole life. I wonder if I should be working when I'm playing with my girl. I wonder if my colleagues are jealous that they don't get more time off to spend with their kids. (They never say anything - I just wonder). Maybe we'd all be better off as doctors, moms and dads, if we had the flexibility to have more time with our families.

Anybody else have doctor guilt, rather than mommy guilt?

Monday, July 28, 2014

Guest post: The whole truth

"Tell all the truth but tell it slant" (Emily Dickenson)

Much is written about how women, and mothers in particular, hurt each other by only showing their competent and successful side. I agree. This isolates us. I’ve had people ask me: “How do you do it? How do you manage being a doctor and a mother at the same time?” Most of the time I say “I don’t know," and that is true in part. I am just doing the best I can and it never feels good enough.

But here is the whole truth. I have a LOT of help. An insane amount of help that I feel embarrassed that I need and for which I feel undeserving. Particularly here in Utah where many women have a lot of children and do a darn good job taking care of them all while looking fabulous in the process, I admit that I feel guilty that I don’t measure up. I feel silly that I have a hard enough time taking care of two.

So here, in a nutshell, is a list of all of the help that I have: a housekeeper a morning per week. And in addition, gulp, a lady who comes two times a week to help with laundry. I shop online and save most errands this way. As if that weren’t enough, I am fortunate enough to have my parents here in Utah. In addition to watching Adelyn during the day, if we are late for school pickup, or if I have a late meeting, my mom is there for backup. Oh, and since we are in full confession mode, also a therapist to help me deal with all the damage done to my psyche by medical training. Have I suffered any real trauma in my life that would actually merit a therapist? Nope. Yep, I am a spoiled white WASP (I’m not actually sure what that is but I think that that is the category people would put me in.) So what am I doing with all this help? Am I volunteering for humanitarian causes? Am I the PTA president? Nope and nope. Here is what I am doing with that time: spending it with my kids mainly. All this help allows me to spend a lot of quality time with my girls. I hope it is doing them some good but I am never quite sure. I desperately want to volunteer to help disadvantaged kids but right now, I have all I can do to take care of my own children. And so I am an armchair do gooder, making donations and all that other useless stuff. I cook several times a week. I sometimes have people over for dinner if the house is presentable enough (though I should do so no matter the condition of the house…foolish pride). I read I bit. I run. When I am feeling brave I take the girls to church on Sunday. I garden and putz around our property. I sit on the front porch and drink iced tea. I occasionally get together with friends or talk on the phone with them or write a letter. Oh, yeah, and I'm a doctor. A decent one most days, and some days a downright good one. If I didn’t have all this help, none of this would be possible.

What are my kids doing while I write this? Watching a dumb cartoon with negative educational value. It’s 90 degrees and in the heat of the day and we already read, and done 2 crafts and some homework pages and eaten and cleaned up and attempted naps and I have no more tricks up my sleeve. And darn it my husband has just arrived home early and caught me ignoring the children while they watch TV.

There you have it. Judge away. Or maybe, just maybe, cut me some slack. Cut other women some slack too. And if you do more than me with less and get by without any help at all, I am truly happy for you. But it's okay that I'm not that way.

I realize that sometimes women take offense when you say things like “I don’t know how you do it.” But when I say that, I am being genuine. The woman with 5 kids--you are my version of a rock star. If I have a lot of questions for you and ask you how you do it, it is because I admire you, like some people might do when they meet a world class athlete or a famous author. To me, you are doing the impossible. The woman staying home with 1, that’s a huge job too. The woman with no children-- wow you must be able to accomplish so much, and gosh it must be so nice to be able to read the paper in bed or join friends for cocktails at night or have a glass of wine on the plane without a small person dumping it out and making the whole aircraft smell like a vineyard and good for you for knowing yourself well enough to make that choice (and if it is not a choice but one that has been forced upon you by infertility, I am sorry and this is why I try not to ask women if they have children lest I hit a sore spot). The woman who has made it to the top of her field? Thanks for paving the way. The woman doing important work to end social injustice? You are ALL my heroes. And I’m grateful to have so many of you in my life.

-a geriatrician and mother of 2

Tuesday, July 8, 2014

Guest post: Pregnant during residency (and not feeling the love)

Prior to becoming pregnant I thought there were no women's rights issues in today's day and age. It was only after I became pregnant that the struggles became all too real. One of the first questions I received from my program director upon announcing my "good news" was...will you take all 6 weeks? Soon afterward a colleague proudly told me he once worked with a resident who was back to work 2 days after delivery. He was hoping my pregnancy would be uncomplicated so I could do the same. Approximately 25 weeks into my pregnancy my physician said I could no longer work solo 24 hr in house calls or 80 hr weeks and that although I could continue my rotation duties, hours should be limited to 12 hr shifts, 5 days a week, maximum of 60 hours. This restriction came after early contractions, shortness of breath and tachycardia had set in.

Although my colleagues weren't pleased with this decision, they agreed to accommodate me of course with the assumption I will be heavy back loaded on calls when I return from maternity leave because each and every hour of call I miss needs to be made up. Made sense to me since caring for a 3 month old should be easy peasy right?

In the meanwhile I continued to work, study, do research, present at national meetings. Pregnancy brain hasn't always helped while being pimped or taking my yearly shelf exam but I have dealt with it as best as I can.  After receiving  two offers for prestigious interviews at two of the top programs in the US for my subspecialty my program director kindly contacted me to recommend that I not go to these interviews and postpone them in the interest of my health and since my schedule was already so "limited". I thanked him for his concern but went to the interviews anyway while 29 weeks pregnant and was accepted by both, able to have my choice!

Now with only 4 weeks of pregnancy left, my physician has recommended no more calls. I of course have worked with my colleagues once again getting them to cover my remaining calls with the promise that I will owe them all back.

I feel a bit like an outcast of the program right now all because I am trying to balance work with a future family. I hesitate strongly to say I am discriminated against but in some senses, I can't help but feel this secretly as well. I keep telling myself that this too will pass in hopes of things returning to "normal" after the pregnancy.

Has anyone else had similar experiences in pregnancy and if so, how did you deal with them?


-An ophthalmology resident 

Monday, June 16, 2014

Guest post: Two points for knowing what you don't know

I’m driving the kids home from school, winding along Dollarton with afternoon sun glinting off Burrard Inlet, and Saskia’s telling me about the Gauss Mathematics Contest she wrote that morning.

“I left one question blank,” she begins. It’s a confession: a perfect score is off the table. She doesn’t add up test scores, she works back from 100. She goes on, “But I did that because of how the scoring system worked. You got six points for a right answer, two points if you left it blank, and zero points for a wrong answer. I wasn’t sure about the last question, so I just left it.”

I make her repeat that, making sure I have it right, because I know I’ll be chewing on this for days.

They were rewarded for leaving alone what they didn’t know.
Making a wild stab at an answer was worth less than no response at all.
For once, it wasn’t about doing one’s best, but about acknowledging one’s limitations.

Screen Shot 2014-06-10 at 11.00.42 AM

* * * * * * *

I was assigned to a family practice when I began residency in 2000, for several 4-week blocks over the two year program, and callback every Thursday afternoon. It was an established practice on Broadway and Granville, and a good group of doctors, but I dreaded seeing the patients, mostly well-heeled reproductive aged women.

Making a diagnosis and treatment plan on my surgery rotation, or in the emergency room, wasn't a problem, but these women kept presenting with issues that weren’t in any textbook. One couldn’t interpret her baby’s cries; another needed advice on dealing with strangers’ remarks on her child’s birthmark; the next had discovered her teenage son’s porn collection. Working at this family practice was by far my least favourite rotation, and I was doing a family medicine residency. That worried me.

My preceptor and her partners took the entire clinic out for Christmas lunch that first year, between morning and afternoon clinics packed with patients wanting to be seen before the holidays. I remember Sarah pausing during the meal and saying to me congenially, “You know when we knew you were okay?”

I had no idea, but I was relieved they’d arrived at that conclusion.

“Remember that rash?” she asked. “The four-year-old with the vesicles on his legs who’d just come back from camping?”

I remembered. Yet another patient that had had me stumped.

“When I asked what you thought it was, you said ‘I don’t know,’” she went on. “That’s when we knew we had a good resident.”

The other physicians agreed. “We don’t care what you know,” said Joan. “We care that you know what you know.”

* * * * * * *

I teach residents myself, now, and it’s true - I don’t pay particular attention to how comprehensive their knowledge bank is, but to whether they recognize what’s missing. Nothing raises a red flag like a learner who already has all the answers.

And then there are the patient encounters where you can’t turn to UptoDate for backup. Sometimes there really isn’t an answer, in that brisk bullet point way that physicians love. Sometimes the P of SOAP feels terribly inadequate; writing ‘counseled’ or ‘conservative’ or ‘follow’ feels like a fail. Physicians get the God-complex jokes all the time, but from where I sit, we're keenly aware of our limitations. Medicine teaches you how very much is unknown.

That's using the Gauss scoring lens to look at one field in one profession. Imagine if we approached everything from a place of humility.

I read comments on news articles on refugee matters, vociferous ones, that are ignorant of the basic facts of the system. I’ve heard someone predict the eternal destiny of another person’s soul with the same degree of certainty that they state their summer vacation plans. I’ve seen someone with no more than Biology 11 comment with the authority of an immunologist on vaccines.

I can't say that those lessons I've learned in medicine have overflowed into every other part of my life, either.

So how about each of us, the next time we’re in a conversation - with a client, in a staff meeting, on social media or out to dinner - consider whether we truly know the answer to the question at hand.

And if not, take two points for keeping our mouths shut.


Cross-posted at www.freshmd.com and www.mothersinmedicine.com


Thursday, May 29, 2014

Guest post: Everything changes when you become a mother

It’s a cliché, and I hate clichés. But it’s also a truth. And it beats me over the head on a daily basis.

I never wanted to be the type of person who thinks, let alone says or writes, that there are things that people without children just don’t understand. And I won’t pretend to know what anyone else feels or understands. But I can say with absolute certainty that my own understanding and experience of life has changed immeasurably since I became a mom. And I’m still trying to learn to navigate not just the logistics of life with a baby, but a very new emotional terrain.

My son was born in February after a healthy, uneventful pregnancy. At three months old, he is thriving – sleeping well, eating heartily, and smiling and cooing in ways that melt my heart anew every day. My husband and I try not to make assumptions about the future, but like all parents, we have high hopes for him. And we look forward to every day that we will spend together as a family, watching him grow and learn and discover the world.

Yet today I am sitting on the living room couch sobbing while my baby naps peacefully in the other room. Why? I am no longer painfully sleep-deprived, no longer terrified that he and I will never master the art of breastfeeding and that he will not gain weight and grow. My hormones seem to be back in check and I have largely adjusted to being back at work and away from him, although it is still hard to leave each morning. I am sitting here in tears because I just read a blog post written by someone I don’t know, someone whose story I came across when it was shared by one of my friends on Facebook. It was about a woman who just lost her little boy to cancer. And I am feeling another mother’s pain.

I can’t imagine what it feels like to lose a child. I couldn’t before I had my own baby, but now whenever I encounter such losses, all I can think about is how, once upon a time, that child’s mother had high hopes for her baby, had her heart melted by each smile and coo. Which is not to say that I would not have cried at the same story before I had my son, or that people without children would not shed tears over it. But the feelings behind my tears – the fiery, gut-tearing pain that churns within me when my mind even dances near the edges of the real question that arises with every story of loss: What if it were my baby being taken from me? – are awful and new.

So with my newfound understanding of motherhood, and the attendant capacity to imagine maternal grief, I face a new challenge. Since medical school, I have wanted to be a pediatric oncologist and treat children with cancer. I adore children, I love working with families, and I am fascinated by the science behind the diseases that afflict them. Back in medical school, one of my classmates confessed that she would have become a pediatrician if she hadn’t already become a mother. “I can’t,” she said, shaking her head and looking pained at the thought of caring for sick children. “I just can’t.”

I did not have children at the time, and although wondered how I might be affected once I started a family, I thought that perhaps I would gain some degree of immunity by entering the field before my own children arrived. When I began my pediatrics residency, I certainly felt sad when children were sick, and extremely sad when they died. But I was able to let go of that sadness and move on.

Then, during my second year of training, my own baby arrived. And after my brief maternity leave, I returned to work on the pediatric oncology ward, a place that had always gripped and excited me. And suddenly everything changed.

I still loved the strictly medical side of things: working up a new diagnosis, puzzling over the best ways to manage the side effects of chemotherapy. But the family meeting to discuss a little boy’s grim prognosis nearly sent me into a fit of sobs. I had to look away and sing songs in my head just to get through it. All I wanted to do was to cry with this mother. For this mother.

Which leaves me in a confusing state. Everything that I have always felt about caring for children, I feel much more strongly now. The uplifting and the soul-crushing both resonate in ways I could never have anticipated. Will this effect wane with time, or intensify? Will it render me better able to care for my patients and their families, or become a barrier to pursuing and surviving the emotions of this career about which I once felt so sure?

It’s hard to know anything for certain, other than, finally, what it feels like to be a mom.


Becky MacDonell-Yilmaz is a second-year pediatrics resident at Hasbro Children's Hospital/Brown University and mom to a three-month-old son. She blogs at The Growth Curve .

Monday, May 5, 2014

Guest post: Gaining More Than Just Weight

Twenty pounds into my pregnancy with no end in sight, I began to dread stepping onto the scale at my Ob/Gyn appointments. Even more, I began to dread that moment in the exam room when my doctor would review my numbers for that day. My blood pressure was invariably okay and my urine dip was normal, but my weight continued to bound upwards in increments larger than what was apparently advisable. I would nod with shared concern as she read out the new tally – seven pounds since my last visit? Oh, my – and with determination as she listed suggestions to watch what I ate and try to get some exercise. Even just take a walk a few times a week, she said. The implication being, how hard could it be?

I would leave the office with new resolve to pack healthier snacks for work and to make time to go back to the gym, or at least to start taking the occasional evening stroll. The snack resolution I met with reasonable success, but the exercise portion proved difficult. Now in my second year of residency, I had stacked my schedule so as to complete my months on certain services – those with the greatest intensity and the longest hours – in the fall and winter prior to my delivery in exchange for a reasonable stretch of call-free maternity leave in the spring. As a result, I left the hospital each night in darkness, exhausted. I stopped even pretending that I might stop by the gym or venture out along the icy sidewalks near my home. Besides, I spent at least half of every shift on my feet, rounding on the wards or hurrying between emergencies. Surely all that activity must count for something.

Hoping that my mediocre efforts had paid off to at least slow the accumulation of pounds, at the next visit I would slip off my heavy Dansko clogs, get back on the scale, and watch as the medical assistant slid the little weights ever further to the right in order to balance my growing mass. Then the entire scene would repeat.

Eventually I gave up.

My new attitude was a mixture of It’s no use, I can’t, and Why bother. I was doing what I could, I reasoned, and if I gained some extra weight, so be it – I would work extra hard to lose it after the baby arrived. I continued to attend every check-up, only now when I nodded at the numbers, my concern was only mild and my determination feigned. I left the office feeling a combination of relief and resignation, already dreading my next appointment.

And suddenly I was not so different from my own clinic patients and their families: from the children and teenagers whose growth curves make me cringe as they surge skyward, brazenly crossing percentile lines, and from the parents (often overweight themselves) who grimace when I show them this evidence of too much intake and too little output – it’s that simple, I explain. They nod earnestly as I outline a plan of attack: cut out soda and juice, add vegetables, find time for exercise. And they look abashed when they return months later to find the curve inching ever onward in the wrong direction.

I’ve been lucky in terms of weight for most of my life. Sure, I’m a fairly typical female; I have certain body parts that I find too loose or jiggly or poorly shaped and I’ve spent too much time staring from different angles in the mirror, obsessing over these flaws. I have gained and shed pounds according to my level of stress and just how hard – probably at times too hard – I have worked to lose them. But I have never been truly overweight, never begun to dance with the complications of hypertension, diabetes, sleep apnea. Never before had a doctor grow concerned about the number on the scale.

And because I had never been in their position, I had never understood how difficult it is to try to get out of it. My belief and the implication of my advice had always been: how hard could it be?

Now I knew. The specifics of our challenges aren’t exactly the same –many of my patients can’t afford to join a gym whereas I pay for a membership and don’t go – but if neither if us is working out, what’s the difference? We’re both gaining too much weight too fast and have been unsuccessful at making the changes our doctors push for. And we’ve both felt bad about it.

I didn’t suddenly develop a grasp of how to move past the roadblocks in my life or theirs. If anything, this new knowledge makes my job even more frustrating and my motivational interviewing less motivational; how can I enthusiastically pitch ideas that, given the backdrop they are set against, are so unlikely to work? What I did gain was new understanding and empathy. And while I don’t have any brilliant solutions to offer to busy, tired people with potentially limited resources who are struggling with the trials of diet and exercise for themselves or their children, I hope that I am better able to partner with them to search for solutions or simply provide support now that I have stood in their shoes . . . on the scale.



I am a second-year pediatrics resident and mom to a 2-month old boy. I blog about my experiences at The Growth Curve (www.thegrowthc.wordpress.com).

Thursday, May 1, 2014

Guest post: Post Partum Pearls

An IM Hospitalist's perspective

I’ve heard that the rigors of medicine prepare women for the arrival of a newborn, and to a certain extent that is true, but there is definitely more to it than that. Our great work ethic, patience, and calmness in the midst of a storm do give us a great base. Also, we tend to “freak out” less over any minor baby medical issues. Despite those similarities, taking care of an infant is quite an unique experience.

It’s been four months since the birth of my adorable baby girl (in my completely unbiased opinion), and I’ve stumbled upon some of my own truths that I felt like sharing.

# First few months are all consuming…kind of like Intern Year

Preparing for childbirth and care takes you only so far, just like prepping for intern year cannot get you ready for the real time situations of the wards.

I was exhausted both mentally and physically in ways I didn’t know I could be. I learned the hard way that keeping my goals simple was key. Feeding, consoling, bathing and carrying an infant is enough for the day. Squeeze in some personal hygiene and eating time and feel good about yourself.

# Infant care is the ultimate roller coaster ride

I recall at the end of my 12 hour day or night of work, my husband would ask how the it went, and in my head multiple thoughts would race, but it was too mentally taxing to convey everything to him, so I’d end up saying “ it was good…” This type of response is quite similar to my days during maternity leave.

There was a mixture of highs and lows and in between. Capturing the entire experience in one sentence seemed unnatural.

# Self-sufficiency is overrated

Though in our profession we are encouraged to ask for help every step of the way, what I’ve found more true with my few years post training, is that most of us strive to work out issues on our own. Asking for a consult every time a question pops up is not an enticing option unless absolutely necessary.

Well when it comes to infant care, support and help are key. The truth is you need your “own time” off from your infant to maintain a healthy relationship. Sure there is satisfaction in bathing, feeding, and nurturing your child all by yourself at times, but not all the time!

Take up your family and friends’ offers to help out. Learn to separate your attending/resident hat from your mother hat! Oh and single mothers, you completely deserve a lifelong standing ovation.

# Don’t feel guilty about not doctoring

As my baby has grown up over past month or so, I have found more free time during the day. At first I immediately thought (after catching up on sleep), that I should do some medicine related things, so my brain doesn’t decrepitate with time. So I filled the hours with intermittent medical reading and reviewing some stuff here and there. I even created my own blog regarding hospital medicine, but as time wore on during my maternity leave, I still found it hard to keep up with everything, and then the guilt trip started. So what I have concluded is to give up pseudo doctoring unless it truly invigorates me, like writing this article. Don’t worry, the skills will not disappear. I realized that after doing a few shifts here and there. You have the rest of your life to doctor away, no need to do fret over it now.

# Embrace your free time, it’s okay to be domestic!

If you’re blessed with more just six weeks off, you will find that your free time will actually increase (not dramatically but noticeably so). I found myself cleaning up the clutter in our apartment and going on an organizational binge. There were moments when I’d stop in the midst of my activities, and think “ oh god, what am I doing?? Did I study, train, work all those hours, and accrue all that debt to only be doing this right now…? “ And then, after bouncing these thoughts off my husband, I slowly snapped back to reality. And reality was pretty great if you are willing to accept it within the context.

For once in my life, I was not working or studying. My hours were completely dedicated to my child and to myself/family. I’d never had this type of time before, except maybe the two months between medical school and residency, except now I was more settled in my life, and that was comforting.

What did I use this time for? Well, to be honest, at first, I binged on TV. Then I started getting into social media especially all the medical related stuff. I’ve also been exploring my creative side again – doing DIY projects for décor, learning lullabies on my acoustic guitar to sing to my little girl, and learning to cook different dishes. It’s been quite refreshing.

Take Away

Overall, it really has been an internship of sorts, and this “learning how to be a parent” is going to continue for the rest of my life just like perfecting the art of medicine never stops. I do hope that my experience will make me a more caring physician when I jump back into the field. I have much to learn, and I’m looking forward to it. To all the other mothers in medicine, I applaud you. I’d love your advice and comments!



@psanyaldey is a 34 year old internal medicine trained hospitalist. She is married and has a mini siberian husky along with her newborn girl. 

Monday, April 28, 2014

Guest post: I'm more like the night-time babysitter

Sometimes I feel like the night time babysitter. I am an Ob/Gyn resident and leave every morning before my 16 month old wakes up (she's a great sleeper, I should be happy). I come home and feed my daughter dinner and supervise the bath, zip up the PJs, watch a cartoon and cuddle while she drinks her bottle, and then its "night night time" and I'm done being a mommy for the day. I could keep her up later but she's tired, and I don't want her being on a special schedule just because her mommy is a doctor.

I hate being a doctor these days. I don't feel important or empowered like people say I should. I know my daughter will one day look up to me as a role model and feel proud of my career, but right now I think she just needs a mommy at home. I don't envy anyone except my stay-at-home mom friends. I wish I knew what it was like to be totally frustrated after a long day of cleaning up plastic toys and missed naps. I wish I knew what it was like to be lonely from lack of adult interaction. Instead I'm stuck taking care of people I don't know all day and getting yelled at by attendings.

I know I'm a "grass is always greener" type of girl, but many days I think I could walk away from this job and never look back. But what would everyone else think? What would my father, who paid for medical school, say? I'm "almost done" with residency-1 year and 2 months left to go, but it feels like forever. I'm already counting down until the day I graduate, so I can take a few months off, and then start whatever Hospitalist job will let me work the least amount of hours. Exactly the kind of career I used to think was an unambitious waste of a medical degree. 

I don't give myself a break or a pat on the back for managing everything. I make sure my house is fully stocked at all times, I sign my daughter up for all of the best classes and lessons (to go to with her nanny). She has an impeccable wardrobe and fresh cooked vegetables in the fridge at the start of most weeks. But I torture myself that I'm not home enough. I cried when my daughter had food poisoning for the first time and I was stuck at work overnight. I refuse to sleep during the day post-call -- what a waste of bonding time. Being a working mom is hard. Being a resident and mom is even harder, but I don't regret having my daughter, she's the best thing that's ever happened to me. I guess I'm crazy, because despite what I've been through these past 16 months, we're trying for baby #2 right now!


Sara, Ob/Gyn Resident (PGY-3)

Monday, April 21, 2014

Guest post: Coming home

I come downstairs after grabbing a few hours sleep in between busy night shifts. I can hear Rose crying in frustration at once again trying to grab the key from the back door. I walk into the chaos in the kitchen. My husband is absorbed in the  newspaper surrounded by the toddler carnage. Why is there breakfast still on the table? Why have the pots and pans been pulled out of the cupboards?  Has she really got porridge still stuck on her forehead and what on earth is she wearing? Oh and why is she chewing hay from the barn?

I open my mouth to say something but hesitate and hold my tongue. I remember that it's his turn to look after Rose while I am in work mode. We do things differently- I'm the surgeon with the perfectionist streak wanting everything to be tidy and clean; he is the artist and is happy to let Rose run free and wild. I smile to myself. 

"Family hug?" I pick up Rose and we all collapse on the sofa together in a warm embrace. A memory to take with me to work that night. Invaluable.



Lotte is a 33 year old general surgery registrar in the UK with an 18 month old daughter Rose and a non medical husband. She works full time.

Monday, April 14, 2014

Guest post: Tales of a hybrid doctor/stay at home Mum-- Part II

April, 2014.

That day five years ago, was the lowest point. (see Part I) Today I work “full time” (whatever that means!) in what is probably my dream job: a perfect mix of innovative clinical care, cutting edge research, medical education and being a leader in my chosen specialty. I am on faculty at one of the most prestigious medical schools in the world and get to work with the brightest and the best, in an environment that is intellectually rewarding and super collegial. …and I feel this is just the beginning!

My husband (who got a raw deal in part I—sorry babe) and I have never been closer and more happier in our marriage—we are both fulfilled in our careers, but most importantly, feel like we are reaping the rewards of our hybrid parenting model now: family life is fun, filled with endless bliss and joy.

Our kids (now 10 and 6) are doing fantastic: healthy, happy and thriving at school and play.

Don’t get me wrong-- it’s a juggling act, for sure, but we are juggling joy and I have never felt more balanced in my life.

Still, the reason I wrote part I is that I never wanted to minimize (or forget) the complicated journey (and decisions) I endured to get me to where I am today.

I only wish my 2014 self could have whispered in the ear of my 2009 self and told her the following:

#1. It will get easier as the kids get older; there will be new parenting challenges and hurdles but the physical dependency will be less and that will give you more freedom. Be patient.

#2.You (as Mum and Dad) have to do what feels right to you (as parents).  This is unique for every single family in the world.You have to decide how best to work to your strengths as a team.Never compromise on your childcare beliefs and preferences.  Do what you think is the right thing to do and everything else will fall into place with time. Your husband is your biggest supporter of your talent and career.  This is, in part, because he is equally passionate, ambitious and talented in his own career.  It’s hard to have two parents be ambitious at the same time when there are two young kids at home.  Right now, you have both agreed it makes sense that it should be his turn, one day it will be yours.  Be patient.

#3. Whatever you do, don’t “opt out”.  You will get deskilled and limit your future career options.  Keep up the hybrid model—it will work to your favor in the end.

#4.  Think of work as a career not as a job.  Keep investing in yourself. When the kids nap/sleep engage in scholarly activities that will keep your CV looking attractive.  You feel like a tortoise right now (and I know you hate that, because you are not a tortoise type of gal) but slow and steady will win the race (one day).

#5.  Stay connected to the reasons you became a physician in the first place.  Don’t’ let anyone distract you from that—these are crucial reasons that are core to your identity as a human being.

#6. Your ARE privileged. Your job entails you coming up with creative solutions to some of the world’s most difficult problems—you impact humanity every time you work.  You also get paid better than most, have societal respect and a “voice” AND have the option to work “part time”.  Many working mothers do not have that type of job. Be GRATEFUL

#7. Don’t become a hovering parent—you have seen them, overeducated parents with time on their hands creating projects in the school so that they can get called to implement them!  Be a good citizen in the school but better you put your skills to use in a zip code that needs your specialized skill set, not the zip code where your kids are lucky enough to live and go to school.

#8. Always DELEGATE non- essential tasks (it will be money well spent) and use that time for love, laughter and being in the moment.  Take care of those who take care of you.

#9. Learn to let go (a little)—it will all be okay.

#10. Don’t pay too much attention to labels, “working mum”; “stay at home mom”; “part time physician”.  Don’t be defined by these terms, they undermine the complexity and power of who you are as an individual. You are unique, you will find a way to make it all work.

Above all remember:

Becoming a mother has made you a better physician and remaining a practicing physician has made you a better mother.


Dr. S is a married physician and mother of two.