Sunday, June 29, 2008

best time for them to have the minor febrile illness...

A question, purely hypothetical of course, on the topic of weekend versus weekday illness. If your child in daycare has to have one or the other, which would you prefer? And I use the word "hypothetical" in a rather euphemistic way for the very actual sense in which this may be happening to my little family right now. Assuming you work Monday through Friday (though I'm sure many of us have schedules that deviate from this traditional schema)... Would you rather that your children have a minor (+/- febrile) illness on a Friday afternoon so that you get to tend to them throughout the weekend, bringing them back to full toddler health as only a mother (perhaps a mother in medicine, indeed) can do by Monday morning? Late on a Friday so that you don't have to miss work, don't have to rearrange child care, don't have to draw upon your colleagues, your relatives, your neighbors, your spouse... Late on a Friday so that your little ones don't continue to infect peers in preschool. Late on a Friday may ruin weekend plans, but is it preferable to ruining weekday (read: WORK) plans?

Or, would you rather that your children begin their minor illness on a Monday and then you get a forced opportunity to stay home for a day (probably more like two or three), put work aside, and mother them back to a usual state of afebrile rambunctiousness? Is it even possible to put work aside? As I think one of my co-MIM-bloggers described that we are in a profession where the world seems to collapse if we need to take a day (or even a few hours) away from our clinical duties at short notice. So, given that your child's minor illness will fall either on a clinical or non-clinical time, which do you prefer?

And, another question altogether, whether you are a mother in medicine or not, do you dose the ibuprofen and send them off to childcare anyway?

Thursday, June 26, 2008

The baby behind the badge

Male resident: "Is there, like, a law that every woman has to have a photo of her baby on the back of her ID badge?"

Me: "Well, we can't put it on the front of the badge, can we??"

So yes, I am one of the many, many physician/mamas who sports a photo of my baby on the back of my ID badge. It covers up the instructions on what to do in case of fire.

I don't want to confess how much time and effort I spent picking out the perfect photo of her to display on the back of my badge. More time than I spend reading New England Journal, that's for sure.

My badge has a tendency to flip around, so that instead of displaying my own photo, name, and job description, I'm walking around the hospital with a photo of a baby on my chest. I'm pretty much the epitome of professionalism.

And of course, I'm always praying that the patient will notice the photo and comment on it, so I have an excuse to talk about her for a minute. A comment that would be great would be something along the lines of: "Your baby girl is beautiful." Unfortunately, comments I've heard include:

"Aw, how old is your son?" (Girls are allowed to wear green, you know.)

"Isn't that ID photo of you a little outdated?" (Ha ha.)

"Wow, you have a kid too? You must be exhausted." (Yep.)

What it all comes down to though is that I love having the photo of her on my ID so that if I'm ever feeling down during the day, I can look at it and feel a little bit better. That or the huge photo album of her that I keep in my white coat pocket at all times.

How do you do it all?

I must admit, I get this question a lot from my patients, friends, and family. Most of the time I try to smile blithely, shrug, and mutter something about "doing my best" or some other such BS response. I often feel that this question must be a rhetorical one, because I highly doubt that anyone really wants to know *how* I manage to live my life. The simple answer, of course, is that I *have* to! Responsibility is seldom pushed upon us in a hurry, like a ton of bricks, it is loaded slowly, ounce by ounce, pound, by pound, until, before you know it, the weight is almost unbearable.

Back in ancient times, when I first started pursuing my medical degree, I was naive to the demands of the profession. It wasn't until I was nearly finished with 3rd year until I realized the gravity of the each patient weighed upon your mind, even after you had left the hospital physically. Unfortunately, I happened to fall in love with a physically and mentally demanding specialty; one with the highest of highs and the lowest of lows. I could not convince myself to turn toward the 9-5 "lifestyle" specialties, and I often feel that the specialty chose me.

Long about the same time, I also happened to fall in love in a different way. This time with a person who was a very good friend, long before romance came into the picture. The solid foundation of friendship is the rock for our marriage, and has gotten us through the rigors of medical training, practice, and parenthood relatively unscathed. But with great love comes great responsibility, and too often I find I need to take more than I can give in the relationship to maintain an overall balance.

Then, the greatest loves and greatest responsibilities of my life came in the form of a beautiful little girl, and a precious little boy. My perspective changed yet again, as I worked harder than ever to support their physical and emotional well being. Working a little later, became exponentially harder, and far less rewarding than it was in the days before my children were in the world.

So I find myself today, bearing the great love and great responsibilities of my profession (and with that, my many patients), my husband, and my children. I find that I am just able to bear the weight of these things, and do a passable job, but I am certainly not doing it all. My health and weight are not especially great, but pushed far to the back burner in favor of "more important" things. The love of all things that I was before I became a physician, wife, and mother, like music and writing and *sleep,* has been shoved further back still.

Something has got to give, and for now, it is looking like I am going to have to unload a few of these bricks so I can breathe and find out what it is like to be me again. I am starting the process of finding a less demanding position, which is temporarily adding more to the load, but hopefully, in time will afford me the ability to enjoy my family and myself once again. I have begun the interviewing process, and I feel a hope that I have not had in a very long time.

So, how do *you* do it all? (I really do want to know!)

Wednesday, June 25, 2008

Goat farming, return to residency or the status quo?

I work two days a week, and I'm home with the kids for three. Apart from a full-time stint when Pete took a ten-week parental leave in 2005, I've never worked more than three days a week since I finished residency five years ago.
You might assume that if I've maintained the same pattern for years, I must have found the perfect balance, requiring little review.
But a typical week of end-of-day comments to Pete looks like this:
  • Monday: "I've been thinking of doing another residency. What would you think of staying home for three years?"
  • Tuesday: "Let's move to the Island and take up organic goat farming. Think how much the kids would love it."
  • Wednesday: "Work's been great lately. Maybe we should pick up another day of daycare and increase my work to three days a week. We could use the extra cash to pay for a cleaner and meals."
  • Thursday: "I've been thinking maybe I should be home full-time while the kids are this young. These years will be done before we know it."
  • Friday: "Why don't you apply to medical school? You could go into family medicine, and we could share a practice. One of us could always be home with the kids."
  • Saturday: "I'd love to throw myself into work full-time, even just for a year or two."
  • Sunday: "Our current arrangement really is ideal. I'm so grateful that I get to spend this much time with the kids. What other career would offer this flexibility?"
These suggestions, and many others, are never offered out of dissatisfaction, but out of creative optimism. An afternoon seeing prenatal patients makes me want to return to the clinic the next morning. But a morning spent hunting for crabs at the beach with the kids makes me wish for a long, uninterrupted string of just such days.
I don't consider the constant consideration of alternatives pathological. For one thing, when you're a physician mother, being yanked in several directions is the norm. For another, I think it's healthy to live with intention, frequently reviewing one's choices.
Before getting a new haircut, my personal rule is that I must want that cut for seven consecutive days. I apply the same basic principle to life changes. When rapidly cycling through ideas, best to sit tight with the status quo, unless an option eventually emerges as the better one.
My fantasy pendulum swings equally in both directions - increasing time at home and at work. The average of all ideas I toy with is exactly what I'm doing now.
Looks like for the foreseeable future I'll continue seeing patients on Tuesdays and Fridays, and spending the rest of the week sharpening pencil crayons and picking berries in the woods.

Tuesday, June 24, 2008

Protected time

For awhile now, I've been in a subclinical funk about work. Don't get me wrong, I love my job and what I do, but over the years in my present position, I've been acquiring more and more responsibilities but not more time or support to do them. Some of it, I'll admit, is self-inflicted. I've taken on a bunch of research projects and mentoring, all important for my academic career and all things I've been told I should be doing. Other responsibilities have insidiously appeared on top of what I already do, or have mushroomed out of existing roles.

I've been wanting to say something to my boss.

My feelings, though, of disgruntlement have waxed and waned. One day I came into work, so fired up by my thoughts of injustice on the commute in, I furiously scribbled a list of Things I Do as ammunition.

I need more protected time.

But, things were busy that day and the list got pushed under a million other things, and by the time I remembered, the fire had smoldered and I thought, it's not that bad.

Another thing was holding me back.

Among my colleagues, I am the only one with children.

I've always feared that saying something about wanting a decreased workload or other dispensation would automatically trigger the - oh, that's the (weak) mother talking. At times, I feel like I need to prove myself as extra-productive to counteract such thoughts. Look! I can do all of this despite having kids!

Yet, the last couple of days were so overwhelmingly hectic that I again felt that need to have The Talk with The Boss. I talked it over with my husband and he agreed: I was doing too much, especially now while I was still nursing my son. But, do you think I should even mention family issues? I really didn't want to. Yes, it is part of the equation but it's not a part I'm willing to admit to my work (male) superior.

So, I sat down with The Boss and explained what I felt. I went over my projects and significant responsibilities, and asked for more protected time.

Which I was granted.
(Where's the Staples' That Was Easy button when you need one?)
I wish sticking up for myself was easier, and that I didn't feel such hesitance due to my mothering identity. Maybe I would feel the same way, even if I didn't have children...women tend to be not as good negotiators when it comes to our jobs.

The extra protected time, though, is a serious boon. I'm glad I said something.

Monday, June 23, 2008

Researching my options for parenthood

Three years ago, I was finishing my first year of general surgical training. I’d love to say my husband was by my side, but he was at home, and I was spending six months in a dingy flat that used to be accommodation for psychiatric patients. It was my first six month rotation away from home, and hopping in and out of the cold bed multiple times on call nights felt pretty lonely.

One night, non-medical hubby asked me to make my career let me sleep at home. Not one full week later, I was approached by my final year tutor and asked whether I would consider a research degree. Bingo-shezam! I had my solution.

Not four months into my PhD program, I turned thirty. Vaguely thinking of fertility and body-clocks, I stopped taking the pill to “see what would happen”. Bingo-Shezam!

Doing self-directed research with preggo brain was a challenge, to say the least. The internet, prime procrastination tool, is just there behind that stats program window! Frantically, I finished what I could and sailed out on maternity leave, just in time for Christmas. Four weeks later, my beautiful Miss Z arrived in a fanfare of electronic beeps, hustled epidurals, botched large-bore IV cannulae and theatre lights.

She has felt at home in the spotlight ever since.

When I returned to study, I compared notes with my clinical friends. I realised I had found the perfect maternity break. Not only had I managed to sneak it in before my ovaries failed, I also had flexibility. The latish start; the early childcare pick up; the day off when she was sick: all unimaginably difficult as a surgical trainee. I even started to congratulate myself - who said there was no good time? Who said you couldn’t have it all?

Miss Z is now 2, and she has been joined by cuddly Mr J, 10 months (who has always been more reserved). I am about to return to the wards, and fellowship exams are just around the corner. I seemed to have blocked out my last few clinical rotations. I have vague memory of having to work weekends. I did have to work late a few nights as well, now that I think about it. Studying was pretty time-consuming too, I recall.

I thought I had found the perfect compromise, and my life was easy. I can no longer even imagine how much I loved helping patients; fixing them. Instead, I can only imagine the wrench of losing wriggly toes in my bed at 7:30, and giggling bathing at five. When I planned parenthood, it felt like something I could control. I could decide what my obligation would be, and what I would expect in return. There would be no compromises, and everyone would be happy all the time.

Luckily, it is much more fun than that.

But I still haven’t figured out the perfect maternity time. Have you?

Dr. Cris Cuthbertson is a surgical trainee in Victoria, Australia. She is currently midway through a PhD on pancreatitis, and will then return for two more years as a registrar before sitting for her fellowship exam. She is a mother to two children - 2 year old Z and 10 month old J. She maintains a blog at, which is focussed on medical productivity, with discussion of medical applications of Mac software.

Married White Female Seeking Wife

Burning the candle at both ends is dangerous...eventually you get burned. I slathered Silvadene all over my ego and am feeling somewhat better.

Intellectually, I realize that I'm trying to do too much - mother, wife, blogger, beader, friend, teacher, physician. I can't do any of it well.

Something had to go. I gave up my scheduled lectures to the medical students. Yes, I'll miss it, but it's one "extra" that I could easily shave off the to-do list. I'll still have first and second years working with me now and then, so it'll keep me connected to the university.

Meanwhile, the house is a disaster. When I get home, I'm too tired to tackle the piles of stuff everywhere.

My colleague said it best: I need a wife. Do you think Husband would mind?

Friday, June 20, 2008

Ataxia versus Balance

Balance is a daily quest for me. Juggling the responsibilities of parenthood, being a spouse, pediatrician, practice owner, and other smaller hats requires the agility of an Olympic gymnast. So I read with interest Lisa Belkin’s article in the New York Times Magazine this Sunday, “When Mom and Dad Share It All”. She details parenting duos who strive for a 50:50 split of all childcare and household duties. One family divides parenting into 3 or 4 molds based on their past and present experiences: “mother-knows-best mold”, “involved dad married to the stressed out working mom”, “stay at home dad”, or a newer mold, “equally shared parenting.”

Me: Which mold do you think we fit into? I ask husband who is enjoying his Father’s Day repose in front of the US Open.

Husband: (grins) I don’t know.

Me: Are we the equally shared parent group or the involved dad married to stressed-out working mom?

Husband: I think the latter would be more accurate.

Me: Hmm

We’ve actually tried on most of these molds in our marriage. There probably was a time as a pediatrician and mother that I thought I knew best. My husband and I have certainly butted heads about this – my husband being more of an authority on the male half of our species than I. Time has taught me that I may be an expert on some matters relating to children, but I always have a lot to learn about my own children and their version of human nature. I’ve also learned how capable my husband is at dealing with our family – that at the end of the day if all are fed, healthy, and content that matching socks, extracurricular activities, and thank you notes can go by the wayside.

The stay at home dad experience was our failed experiment. After a challenging experience with a nanny, my husband decided to be the stay at home parent with our then seven month old son. Belkin and Marc Vachon (one of the interviewed fathers) say that this parent is “cooed at for his sensitivity but who is isolated and financially vulnerable as the stay-at-home mom.” That pretty much hit the nail on the head. Living in a small, conservative town worsened the loneliness for my outgoing husband who was used to the daily traffic of his office. Ultimately we moved to a larger community so that we could find support and reinvent our parenting roles.

Our current mold is a hybrid of stressed out mom and 50:50 parenting. Some days are 10:90 when I am on call and my husband picks up, feeds, and completes homework with the boys. Other days are 50:50 when we divide and conquer the birthday party gift-buying, drop off and pick up. The stressed out part comes from my own personal parenting standard getting in the way of just doing it. I don’t always know where these standards come from, but they are very persistent and immediate. This week is a good example. The boys are enrolled in soccer camp, and I have found myself micromanaging the clothes, water bottles, and drawstring bags for each day. I don’t have any idea where this standard comes from that both boys need to have these things and look like they’re playing in the World Cup.

With the exception of reading articles about co-parenting in the NY Times magazine, I think less about the division of labor in our household than I used to. Keeping track of how much work at home each parent does isn’t very fruitful. It either makes me anxious that I haven’t done enough and I overcompensate (read stress out) or I’m resentful that I have so much to do in a short period of time (more stress). Looking at the big picture helps – the important things are getting done and accomplished. What didn’t get done probably didn’t really matter that much.

Wednesday, June 18, 2008

The Sucking Machine

I recently gave up nursing. That part was hard. Giving up pumping was easy.

I'm going to go out on a limb and say that nobody likes breast pumping. When you're nursing, there's that wonderful bonding... but when you pump, it's just you and The Sucking Machine. It requires a tremendous amount of dedication for any woman, but I really think that it's harder for a physician-mama than most. And even harder if you're a resident-mama.

The problem with being a pumping resident is that there's no natural break scheduled into the day where you can retire into the coat room with your pump. On clinic rotations, I usually ended up working right through lunch, so no free time there. On ward rotations, there was usually some downtime, but I always lived in fear of hell breaking loose mid-pump. And ladies, is there anything more embarrassing than answering a page with your pump going in the background?

Some women I know in non-medical professions told me that I "have a right to be given time to pump!!!" (Note the use of multiple exclamation points.) Unfortunately, it doesn't really work that way in the hospital, especially if you're the lone resident on the ward.

Nurse: "Mr. Smith is having 10 out of 10 crushing chest pain and shortness of breath!"

Me: "Sorry, I'm on a pumping break. Try me again in 20 minutes."

Since I had no office, most of my pumping for the first three months was done in a "family room" on the inpatient ward, which was usually unoccupied. Unfortunately, the room had a bed and several patients' families were convinced I was going in there to nap. I wish.

After that, I moved to a different hospital and I had two choices for pumping: Empty Patient's Room or Glorious Pumping Lounge. Glorious Pumping Lounge had everything but a running waterfall in the background, but it was a five mile trek in hiking books from my ward, so I usually opted for Empty Patient's Room. And routinely got walked in on by the janitorial staff.

I managed to pump until Melly was seven months old, exceeding my goal of 6 months, and I nursed quite a bit longer. I think I did good. Next time I'm going to go for the whole year.

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.

Monday, June 16, 2008

Babymaking in residency

I promised an entry about when is the best time to have a baby during residency. In answer to this question, I would like to tell a little personal anecdote that still grinds my teeth two years later:

During my last month of internship, I discovered that, much to my delight, I was nearly two months pregnant. About week or two after my positive pregnancy test, after a particularly rough call, I started bleeding. Then cramping.

Those of you who have been through this (or even those who haven't) will probably understand how rough this was for me. Physically, I was in a lot of pain. Emotionally, I was a wreck. I won't get into the details, but there was crying. And I was unfortunately in the middle of a two week stretch with four calls and no days off. (Ah, internship...)

When the pain got unbearable, I talked to my senior resident about it and she suggested I ask the chief resident for help. I had one short call left the next day with a doctor's appointment in the afternoon, and I asked if I could have coverage only for the admissions until 10PM. The chief agreed. An intern was pulled off their cardiology elective for that day and would cover my admissions from 1-10PM, then have most of the next day off as a reward (while I covered the post-call issues). I spoke to the covering intern, told him what was going on, and he told me he was glad to help me.

I wish the story ended there. I mean, it's not a GREAT story, but at least I was given help when help was needed. That day, I came home from work to an email from the roommate of the intern who would be covering me, who was a transitional intern in our program. Someone I had actually considered my friend. (Also, incidentally, a Harvard-educated doctor.) The email began:

I'm sorry to hear that you are sick...

Silly me, I first thought that the email was to wish me well. Instead it was a nasty email, criticizing me for not taking that call. Saying that I was imposing hardship on his poor roommate, who was studying for the Step 3 boards. (I was actually pulled to cover for someone close to my boards too.) It ended by saying that he wanted me to "reduce my leave".

Even though everything worked out in the end, I will never forget that email for the rest of my life. Even when I'm old and senile, this will be the story I'll be telling my bored family members over and over. I finally emailed the resident a year later and told him (politely) how hurt I was by what he said to me. He wrote me back, saying he wished me well, but did not offer an apology.

All this for taking ONE NIGHT off while in the middle of a threatened miscarriage. Not even a whole day off. Thus is internship.

I hoped I was an exception, but I recently spoke to another resident who had an almost identical experience. After a particularly difficult call while she was pregnant, she started bleeding and cramping. (This seems to happen a lot... we should start a Bleeding Pregnant Residents Club.) She was allowed to take one call off, but all the other residents were suspicious and critical of her. And she had to make it up by working the next six weekends in a row or something insane like that.

So that is my experience with pregnancy in residency. Proceed with caution.

Sunday, June 15, 2008

Love my job?...depends when you ask

This work-family balance is very tenuous. It's Sunday night and after a relaxing, fun-filled weekend with the kids I am dreading going to work tomorrow. I will miss them. Not to mention, I just sat down at my computer to 'check in' and am reminded that I have a ton of email to respond to, a ton of projects to keep moving forward and a busy week ahead. So as I sit here desperately trying to organize my life before the craziness of the week, I have fleeting thoughts of what it would be like if I didn't have to do all this, if I didn't work and if I could just kick my feet up and watch a little TV or read a book...(what I am convinced 'normal' people do).

...and yet I know that at around 2pm tomorrow when I"m in the thick of it at work, intellectually engaged, stimulated and satisfied after helping a few patients, I will feel content to be working and perhaps even excited about some of the projects with the residents. I will walk to my car tomorrow evening thinking about how happy I am with the balance in my life and how I would be intellectually bored if I didn't have my work.

...and then I will go home, play with the girls, cuddle them to sleep and wish again that I didn't have to wake up so early in the morning to go to work.

Mommy Daddy Mommy Daddy

Although their first early utterances often sound more like "Da Da Da Da" rather than "Mommy, Can I Have More Breastmilk And By The Way, Thank You For Everything," when you share your children with a father who is as dedicated as my husband, you don't mind that the kids initially and still sometimes call you Daddy, or the more formal "Mommy Daddy Mommy Daddy" even when they are Just Four and Nearly Two. After all, upon looking through our wedding album on recent nights, Just Four decided that she will either marry her brother or her father. Perhaps reasonable, given her vantage point, but not legal. Here are just a few loving witticisms, courtesy of my kids, in tribute to the dads out there:

"I'm going to love you every day, and I'm not even going to skip a day"

"I had a dream that I loved you"

"I love you.... table"

"Happy Mother's Day Daddy"

As a post-script, allow me (a mother in medicine) a brief shout out to my own father (neither a mother nor in medicine, except he was the latter, I guess, as a patient succumbing to cancer over 15 years ago). When I casually mentioned to my daughter that the Berenstain bears book we were reading was one that "my parents" read to me when I was little, she asked, "Who was the Daddy?" For the first time a clear reference to my father, her should-have-been grandfather. And I told her, "He was a wonderful man who read me books and taught me to swim." I miss father's day.

Father's Day

Happy Father's Day to all of the men that help us do what we do! My gift to you is a heartfelt quote from John Gregory Brown in Decorations in a Ruined Cemetery, 1994.

There's something like a line of gold thread running through a man's words when he talks to his daughter, and gradually over the years it gets to be long enough for you to pick up in your hands and weave into cloth that feels like love itself.

Saturday, June 14, 2008

Top Ten Pearls

This is a shameless plug for an excellent writing conference that I attended this spring in Boston. Publishing Books, Memoirs and other Creative Nonfiction (aka Harvard Writers) is a classy conference directed by tireless and enthusiastic Julie Silver, MD. Authors, agents, editors, and publicists gather to teach the medically minded about the publishing world. I even got 25 CME credits for attending!

One of the standout presentations, and there were many, was Pauline Chen, MD. Dr. Chen's first book, Final Exam: A Surgeon's Reflections on Mortality, is a New York Times Bestseller. She shared with us her Top 10 Pearls about writing in David Letterman style.

  • 10. Study for your boards - attend writing programs and conferences. Dr. Chen went to the UCLA writing program

  • 9. Practice your knots - write. write, write

  • 8. Go through rotations with an open mind - be prepared to be surprised about where this writing journey takes you

  • 7. See a donut/Eat a donut - Eat for free - Read as much and as widely as possible especially in your own genre

  • 6. Better is the enemy of good (Voltaire) - Make the jump! Sometimes you have to stop writing and try to publish

  • 5. Don't apply to just one program - Find someone with similar interests and meet them (personal thank yous to Fat Doctor and KC for getting me started)

  • 4. Make a list of 10 most important things in life - sometimes it takes reestablishing priorities to write/blog - For Dr. Chen: Sleep when you can, eat when you can, write when you can and don't mess with the pancreas applies

  • 3. Remember your residency - You survived/are surviving residency - you can write a book/blog

  • 2. A good senior resident is a good team player - publishing requires same set of skills: be polite (give credit where credit is due), be prepared, be punctual

  • 1. Trust no one - trust only your voice and find it by reading and lots of writing.

And in case you think I've lost my mind and forgotten that this blog is supposed to be about mothers in medicine, writing makes me a better parent and I hope a better physician. Maybe it's the political climate, maybe it's too much JennyMcCarthy's rant on vaccines and autism, but medicine seems to be taking a beating. It's important for those of us in the medical trenches to have an outlet to be heard. Honor and integrity still exist in medicine, and we are uniquely positioned to tell that part of the story by wearing our mom and doc hats simultaneously. Write with abandon!