Showing posts with label juliaink. Show all posts
Showing posts with label juliaink. Show all posts

Wednesday, February 11, 2009


I went through medical school at the edge of the first large wave of women admitted since the forties. In the 1970s, the whole concept of mentoring was murky. Daniel Levinson’s book on adult male development had highlighted the importance of mentorship, mostly in the business context and mostly from the point of view of the value of being a mentor. We called our mentors advisors. In college, my relation to my advisor was distant—I doubt she could have picked me from a police lineup—and medical schools had not yet recognized the need.

Beyond the deficits of the system, being a young woman in an environment where all the potential mentors were older men, I felt uneasy about seeking a mentor. The boundary between mentor and puppetmaster was too thin. Though I aspired to an academic career, I knew that the careers of my possible mentors were not for me. I wanted a family, and I was not prepared to work evenings and weekends on articles that might add weight to my resume but only add burden to what others were expected to read. How to be creative, individual, and sane were my goals, and the few senior faculty who reached out to me, or who I approached, could not really speak to my condition. The best one of them came up with was that I was promising but an underachiever.

Fortunately, though I lacked mentors, I had models aplenty. I admired extravagantly the men who taught me, mainly by example, how to be a teaching doctor. I remember seeing my physical diagnosis tutor examining a patient’s abdomen. He was a big guy with huge hands, and the gentleness with which he showed us the liver edge moved me almost to tears. I knew my hands would never look like that, and that I would have to struggle not to seem sharp and small touching people, but I did learn that a doctor’s touch could warm and heal as well as probe. Another tutor took us to see a man (whom he did not previously know) who was recovering from a stroke. The man’s worried wife was standing behind him. My tutor managed to demonstrate the extent of the patient’s continued paralysis, while his words to the patient and his wife conveyed how much he seemed to improving. Neither of these men will ever know the impact that observing their blended skill and compassion had on me, but neither will I ever forget those or other moments that so nourished my growth from student to doctor.

Now I am in a position to mentor students myself, and I find it tough going. They are so silent, so fearful of expressing themselves, of making errors or seeming uncertain. I can only hope that they see me the way I saw the people I admired. Perhaps someday something I did or said will be communicated to other students as an example of what good mentoring can be about.

Monday, January 5, 2009

Cultivating Friends While Raising Children

The request for reading suggestions got me to thinking about the problem of finding time for adult pleasures when life is filled with work and children. Although we see plenty of people in our work settings, that is different from having friends. We are necessarily reserved with patients, and we tend to be (or struggle not to be) competitive with colleagues and directive with staff.

It takes a conscious effort for working mothers of any stripe to maintain or seek friendships. On the one hand, our children’s activities bring us together with parents of children of similar ages. Some of the best friends I have made as an adult are women I met that way: in a prenatal exercise class and the mothers of my daughters’ close friends. Even the girl scouts have provided some great connections (though with continual dodging and weaving to avoid being the cookie mom). But it is not always easy to find common ground outside of parenting, and when children change their friends or their activities, these ties can easily fray.

I have tried lots of other ways, including book clubs (but then you have to read the books), exercise classes (never a good bet for an unathletic soul like me) and various volunteer activities. What has worked best—and sometimes wonderfully—has been to get involved with things I love for their own sake, to which I can bring a child sometimes. The real lifesaver was finding an opera company that had chorus parts for adults and children. I brought along two of my daughters, and while I never graduated above second alto, the experience brought out my daughter’s latent musicality and has formed her career as an adult.

It is important to find something that is more than a single time event, that offers both continuity and flexibility. The Sierra Club, with its multiple local outings, can be great for that. The other thing I have learned is that with effort, one can learn not to strive for excellence in everything. We have been such achievers, it can be a surprise to realize that a fifth rate production of one act plays is still fun and that other harried but interesting people may be drawn to similar things.

And of course, my lifelong addiction to books with series characters—from Nancy Drew to Harry Potter and mystery series too numerous to mention—means that whenever I want to visit an old friend, someone completely undemanding is always at hand.

Do others think about this? How do you stay yourself while taking care of so many other people?

Wednesday, November 12, 2008

Express Yourself

Most medical schools have satirical student productions. The most rewarding thing I did in medical school was to be deeply involved in ours, called the second year show. I can still remember classic skits: the first year student doing a physical on a cadaver and missing that the patient was dead, for example. The accompanying song still runs through my mind whenever I teach phyisical diagnosis. Playing music, singing and dancing with classmates is a tremendous counterweight to both the isolation and the competitiveness that seem to be a leitmotif (or maybe I mean heavy motif) of medical

Monday, October 20, 2008

Notes from the Parents' Axuiliary

I am a psychiatrist married to an academic. In our family, “Take Your Daughter to Work Day” ranked somewhere between Groundhog Day and National Oatmeal week as a celebration. It was nearly impossible to bring our three daughters into our worlds when they were young. Instead, we tried to enter theirs. Their dad coached them, we devoted Saturdays to swim meets. We never missed a concert or a play, even when a daughter had a non-speaking part as an inanimate object, or had only built the set. I, for my sins, had three painful years as a Girl Scout leader (anything, anything to avoid being the Cookie Mom). I learned to make wax dolls for dioramas, where to buy poster board at midnight, and which thrift store racks have the best fairy princess costumes (sleepwear, hands down). Still, the girls grew away from us, with their own friends, their own media, their own intellectual and academic accomplishments. Their growth left a hole in my world, and I missed my dwindling role in theirs (except for the Girl Scout leader part).
Now the dynamics have changed. Yesterday for me was “Take Your Mother to Work Day.” I volunteered in the campaign office where my daughter is an organizer. She put me through the training program with focus and poise. When I brought back my tallies, she patiently corrected my work, with generous dollops of humor and tact. To my surprise, I found that I am a Jill-come-lately to the mothers’ auxiliary of this campaign. Many other volunteers had brought parents to work with them. It wasn’t cute, like having kids in your cubicle, but it was a statement of loyalty and closeness that warmed my heart.
I guess I should not be surprised to follow rather than lead. My husband dragged me from the world of WhiteOut and erasable bond into the computer age, but it was the children who introduced me to Hogwarts, the internet (from which they still must still untangle me from time to time), and, eventually, to the worlds of opera, competitive ballroom dancing, and now voter organization. Lately, I have even tried to develop some enthusiasm for math and computer science. My daughter has been kind about it.
At one time, my sphere as a parent seemed narrow—medicine was my window into the world outside. A doctor’s experience is both wider and more circumscribed than many. We are involved with people that most others in our social class never see. They are always on our turf, however, and we too often meet them with their clothes off and with the richness of their experience cloaked in a veil of illness.
As the girls grow past college, the time they seemed farthest away, I am entering a wonderful phase of parenthood. My adult children bring back the broad horizons I once had, offering me opportunities to visit and live in worlds beyond my office and the hospital. To see them working, to engage in conversations in which they are the experts, and I the novice—these things bring intense satisfaction that mothers of young children can only dream about. Dream on, sisters, the day will come.
And did I mention that my daughter does a great job at her job?

Thursday, September 4, 2008

The Elephant in the Room

I, like many women, and perhaps like physicians in general, am averse to political activism. Medical problems have, or we are taught to think they have, right answers. Controversy and disagreement are uncomfortable to us, implying that our judgment or knowledge is somehow at fault. Even the formal exercise of an M and M conference does not help us recognize and accept legitimate differences; at the end of the disagreement, the pathologist is there to provide the single right answer. And as women, we want to make others feel accepted and comfortable. So I am reluctant to take a political position in this blog. Some of my best friends, etc....

I am not about to rant on either candidate, but I do want to share my dismay at some of the health care issues that are going to be affected by the outcome of the next election. A friend of mine in Hawaii wrote to me that blue cross/blue shield in her state requires women to pay higher premiums than men--and gets away with it! Yes, women have expenses related to reproductive care that men don't, and yes, we live longer. But the whole idea of health insurance is to spread risk fairly through a population. Differential pricing by gender implies that men are the true representatives of the population and women somehow deviant from the norm (despite being an absolute majority). This stands the very edifice of health insurance on its head.

Beyond reproductive health care services like abortion and contraception, adequate insurance for the elderly, including nursing and other support services, are also "women's issues." When insurance fails to cover services, it is typically women--wives and daughters--who pick up the responsibilties of caregiving. When insurance does not pay for services for children, it is mothers who step in fill the vacuum. Now that women are more productive in work outside the home, the economic costs of us having to cut back our own work to become caregivers are huge, and rarely acknowledged.

The underlying problem is one of state/federal conflict, not necessarily Democratic/Republican differences. The regulation of private health insurance is a state rather than a federal function. Many insurance companies have budgets--and therefore political clout--larger than the state governments that regulate them. Only the federal government is large enough and strong enough to rein in the rogue health insurance industry. Personalities and records aside, this mother in medicine is going to vote for the candidate who believes in using the power of government to regulate crucial service institutions directly, not through byzantine manipulations of the tax code. Three guesses as to who that will be.

Tuesday, August 26, 2008

The Speech I Never Gave

Being on a medical school faculty, I have just listened to a slew of speeches welcoming the new students. Everyone from older students to the dean exhorted the students to be diligent, caring, dedicated and so on, and tried to capture the transformation that occurs between layman and doctor. The students all seemed overwhelmed, being told medicine would be a rewarding but all consuming life. While the speakers honored the families from whom the students came, none said anything to reassure them that their future lives might include families of their own. I listened with the ears of the lonely single woman I was on my first day of medical school, and I felt the mixture of aspiration and despair the dean’s vision evoked.

As my family has observed, I always want to be the bride at every wedding and the corpse at every wake. Sitting there, I tried to think what I would want to tell the students, especially the incoming women, about what lies ahead. I suspect a more feminine image of devotion and change might have been of comfort to them. After all, they are joining a profession, not a convent or a monastery.

Becoming a doctor, I would have said, is a lot like becoming a mother. When you imagine it, based on the images of motherhood that surround you, the vicarious experience of friends or family, and your own experience as a child, you imagine the change occurs suddenly and thoroughly. The baby is placed in your arms, you expect to be flooded with tenderness, to know what to do in every circumstance, and to have the respect of those around you. In fact, the process is gradual. The day you find out you are carrying a child is like the day you get your medical school acceptance letter. The child grows in your mind and occupies many different roles before it ever becomes a flesh and blood reality. How many different specialties did we practice in our heads, before we put on our first white jacket and tried to find a comfortable place to stash the stethoscope? Delivering the baby, like the first day in anatomy lab, doesn’t suddenly make you a mom, or a doctor, not the way you imagined it would. It takes time, sleepless nights, anxious days, moments of profound resentment and moments of even greater tenderness before you fall in love with this child, a love that evolves and changes as the child becomes more and more complex and separate from you. As with medicine, the more fully you embrace this new focal point in your life, the more your inner sense of self changes. Various milestones—the child’s smile, the end of your first period of exams—mark progress toward your new self, but the real transformation occurs privately. It can be sudden—the day someone calls you mommy, or doctor, and you don’t jump. More often, it is retrospective. You look back and realize that somewhere in the past few weeks, months or years, you have become what you and others have expected for so long—still yourself, yet profoundly and irrevocably other than what you were the day you first began to dream.

Do not be afraid, I would have said to them. The sacrifices you will be making will not be more than you can bear, and the rewards will be more than you can imagine.

Wednesday, August 6, 2008

Lucky Mother of Daughters

Being a mother of daughters provides excellent cover for rereading the classics of childhood, to see if they would appeal to my children. Although the girls are now somewhat out of range, reading sci fi, feminism, and Dostoyevsky, I still enjoy the guilty pleasures of the Little Princess and Little House on the Prairie. This week, I fell into Eight Cousins and Rose in Bloom (Louisa May Alcott). I hadn't really reflected on these as a physician before, and I was struck by several thoughts. In the modern age we tend to forget the catastrophic role of illness in many lives, since few of our patients come down with "malignant fevers" or die of sudden injury. But to those patients who are afflicted (lovely Victorian word), the experience is as devastating as it ever was. Conversely, the role of the doctor who can be trusted to know what to do is extraordinarily valued and important. To be a doctor is a burden, without doubt, but it is also an enormous privilege. And the guilt we feel not being with our children as much as women in some other professions may at times conceal or be compounded by the guilt that comes from our enjoyment of our professional work. When I am arguing with an insurer, or dealing with a messy and uncertain medical situation after hours, I resent the demands of medicine, but when the door is closed and I am deep into session with a patient, I imagine it is like being in the middle of surgery. There is no where else, including home, where I would rather be. Accepting that half measures in two demanding arenas adds up to more than one whole life has helped me navigate the shoals of combining medicine and motherhood, even when the tide is ebbing and the sailing requires some tricky maneuvers to keep the ship afloat.

Tuesday, June 17, 2008

Mims with older kids

My three daughters are now just in and out of college. Somewhat to my chagrin, not one of the three has any interest in science or in medicine. I am the child, niece, cousin and sister of physicians, and I wonder what this means. I have certainly loved having a profession, and I don't think my children have suffered from any lack of my involvement in their lives. (If anything, they have benefitted from me not helicoptering over their choices and experiences.) Yet when it comes to choosing a career, they look to their father and their peers. All are aspiring to change the world in some fashion, but medicine no longer seems to promise that, as it did when I was going into the field. Remarkable lack of interest in medicine in the children of female physicians was noted by Diane Shrier in her research on mother daughter physician pairs. I wonder if the children of male physicians, or the male children of female physicians, are any different.

Tuesday, May 27, 2008

Maternity leave for medical mothers

The association of directors of residency training in psychiatry has just started surveying program directors about their ATTITUDES toward maternity leave for residents. Years ago, when I was a member, I tried to survey them to find out what the range of actual policies might be, but no one wanted to disclose this for fear, I guess, that women would choose programs with better policies. Still, this punt is a form of progress, and the day may come when young women may have that kind of information, and not be penalized for making use of it.

Since I have changed to medical student education as my professional focus, I have become even more concerned about this issue. My first year in the job, an excellent student failed her clerkship exam about a month after delivering her first child. This led me to research the issue of "motherbrain"--cognitive problems women report after delivery. (I recall my pregnancy friend describing it as "someone took my brain out, administered a few swift kicks, and replaced it rotated 45 degrees.") Although the problem is one women commonly report, the research on it, like earlier research on perinatal depression, has been dismissive. Because the studies all exclude women with depression, severe insomnia, or medical complications, they have not found "objective" evidence of impairment on a limited number of tests.

Research or not, cognitive impairment (poor concentration and short term memory) may be a significant problem for women after delivery, lasting an unknown period of time. While I don't want to discourage anyone from working and demonstrating that mothers can be competent professionals, inadequate maternity leave and too early return to work is not a trivial problems. Students may fail their exams, and the rates of human error, already too high in medicine, may be affected as well. If I thought the information would be used in a non discriminatory fashion, I would be advocating for more attention to research in perinatal cognition. As it is, I try to warn students and residents not to underestimate the impact of childbirth, and to take adequate leave, even if it requires financial sacrifice or prolongs training.

Has anyone else been concerned about this?