Tuesday, July 22, 2008

When I retire perhaps I'll be a daycare provider

I took a vacation day from pediatric practice a few weeks ago to accompany Just Four (and 15 classmates) on a trip to the National Zoo. My daughter and I (and 15 classmates) walked that whole zoo up and down. Fun but tiring, and I still crazily fantasize that someday when I retire from general pediatrics I'll be a day care provider. Assuming I receive the proper training, of course.

But for some time until I retire, I'll be a pediatrician and have children in day care, so I will struggle with various options when it comes to hiding or sharing a vast array of pediatric (and other) medical knowledge. Do I let them know that teething isn't the cause of the 102 fever? That one doesn't actually get a cold from being in the cold. That diarrhea is usually contagious but eczema is not.

Do I show them my technique for reducing a nursemaid's elbow? Perhaps it's best to just do it myself--on my own child yes (twice) but on a classmate? I'll presumably gain some cred in the process, as an unintended but welcome side effect. That cred can go a long way when I assure them that my child who was sent home yesterday vomiting raisins is actually fine today and able to stay and play.

And in preparation for my retirement position, I'll take note of all that I can learn from the day care providers. How do they get my children to nap, everyday, let alone getting 12 toddlers to do so, at the same time, under one roof? When I asked, they laughed it off. And when I asked again --it wasn't a rhetorical question-- they explained, "Oh we just tell them it's nap time and turn down the lights and read a quiet story." Ah, that's how they do it. I'll think I'll try that at home.

Someday I'll "retire" and become a day care provider so I can continue the teaching and learning cycle. I'll greet the parents in the morning and late afternoon with information about their precious children. I'll read books to my class, tell them stories, and hear their tales. I'll feed them healthy food. There will be no potato chips in my day care. They learn not to bite each other. I'll teach 16 preschoolers to skip and 12 toddlers to jump. They'll all know how to dance. I'll be tired, but I'll nap too. When I retire.

Monday, July 21, 2008


Before I had a baby, I didn't really believe all that stuff people told me about how the baby constantly cries and wakes you up all night. I thought that was just something they added in movies and TV shows for comic relief. And even if the baby woke up a lot, so what? I had survived med school and internship! This was going to be like a walk in the park.

But then I had a baby and OH MY GOD. I didn't understand how any woman ever had a second one of those things. (It did get better though.)

I was recently discussing this topic with a fellow female resident/mama and we decided that between internship and the first month of your baby's life, that first month is much more exhausting. In fact, that first month is not that unlike internship...

10 ways that intern year is similar to the first month of your baby's life:

1. You are constantly bothered by family members who think they know how to be a better mother/doctor than you.

2. As a new mom, you spend 90% of your time in pajamas. As an intern, you spend 90% of your time in scrubs, the pajamas of doctors.

3. In the beginning of internship, you're woken up pretty much every hour. Then as you get more competent at remembering to do things like, oh, sign your orders, you get woken up less. In the beginning of motherhood, you're woken up pretty much every hour. Then as your baby gets fatter, you get woken up less.

4. Even when you finally get to sleep, you remain in a state of catlike readiness.

5. Weekends, as you've previously known them, cease to exist.

6. You deal with poop a lot.

7. Hygiene falls sadly by the wayside.

8. You're constantly worried that something bad will happen to your patients/baby.

9. 99% of your meals come out of a container that says Kraft or Cup of Noodles on it.

10. For once, you sort of feel like you have a purpose.

Sunday, July 20, 2008

My Sanity

I feel like I’m cheating to write for this site. I have a secret. Much like I used to feel a little guilty when my gynecology patients would say “I’m so glad you’re a woman because you understand how I feel.” Truth is while I do, in fact have a vagina and need pap smears, I’ve never had cramps, contractions or even *gasp* a yeast infection. I also haven’t had a period in the 2 years (thank you Mirena). Until I had a baby I felt very little connection with my patients. I tried to distract you, but alas my secret. My life’s not that crazy. My husband’s a Super hero. He’s a stay at home dad and that makes our lives sane.

We met in high school, dated in college and married before I started med school. Our dreams we’re simple. I’d be a family practitioner; he’d be a history teacher. We’d move to a ski town have 2.5 ski bunny kids and live happily ever after. Needless to say, 2 weeks into my first FP rotation and I knew that wasn’t for me (same goes for his student teaching). I went on to be an OB resident and he became computer network administrator extraordinaire. We ended up about 3 states away from Colorado. When I became pregnant with our Boy Genius during my 3rd year we ran the numbers. It just made more since for him to stay home, and he genuinely wanted to. I have to admit, to be honest, I was a little skeptical. I wasn’t sure how he would handle it, how it would affect the dynamic of our relationship or even, I hate to admit this, what people would think.

The transition went fairly smoothly. He worked until I was done with maternity leave then he accepted a new position of full time dad. He quickly realized that it wasn’t all Sci-Fi channel and bon-bons. Also he learned it’s a bad idea to take a 7 week old to see Lord of the Rings (sorry honey, I’ll never let you live that one down), but over time I grew amazed at his patience and the way he became the most amazing father I’d ever seen. It was hard at times when our son preferred him to me or when our overly picky son would only eat when he fed him. I remember being horrified in the airport when I tried to feed him and he wouldn’t eat for me. I had to have my husband do it and I felt like a fraud of a mom. I soon learned that that was just part of our arrangement.

I feel more connected to him than I ever have before. I hold him with even greater respect. To be honest after working 10 hours and delivering a million babies, when I don’t also worry about cooking, cleaning and picking up laundry, it leaves a lot more time to focus on our relationship.

When our son was about 6 months old my 2 best friends came for the weekend. They had never been huge fans of my husband. During girl talk, later in the weekend, I began to slightly complain about him. They gave me THE LOOK. “Stop it right there” they said “you’re never allowed to complain about your husband EVER AGAIN.” After seeing his super dad skills, my stay at home mom friends had changed alliances forever. Occasionally we’ll get an odd look at a party when we get introduced to new people, but at this point it bothers neither of us in the least.

He was a little lonely at first while I was a resident, but once in practice we moved (yet further away from skiing). Here he’s involved with a dad’s playgroup and has stayed well connected to society. Also he seems to get volunteered often in the neighborhood and at church, so his social schedule stays quite full. This arrangement has worked amazingly well for us.

Currently life is smooth and fairly peaceful. We are unpatiently waiting to adopt baby #2, so we’ll see how our sanity holds up when we add another to the mix.

Thanks for letting me join the club.


Fathers and parental leave

"Working at the downtown east side clinic was a walk in the park compared to being at home with the kids," I commented to someone recently, referring to my experience when Pete took parental leave a few years ago.

"Your job must not be that hard, then," he responded.

That is exactly why I think it is so valuable for fathers to experience being the primary caregiver to their children, if only for a few weeks.

When our second child was born, Pete took ten weeks of parental leave. "I'm going to take Saskia [the three-year-old] to the beach every day," he told me happily as he planned his time off.

"What about the baby?" I reminded him.

"Oh, yeah." Pete paused to consider this. "He can come along too."

I couldn't fault his ambition. I was the one who had planned to learn to play piano, take up sewing and audit an architecture class during my first maternity leave.

After two weeks of caring for an infant and toddler, laundry, cleaning and meal preparation; of cycling through endless menial tasks, Pete began the countdown to his return to work.

"Five weeks down, five to go," he announced one night.

I did a mental calculation. "No, four down and six to go," I corrected him.

He was crestfallen.

Meanwhile, I was having a fantastic time at work. I clocked in at 8:30 and left at 4:30. It was civilized. I dealt systematically with one issue at a time. It was stimulating, an academic and clinical challenge. Every day I spent an hour eating lunch with a book in hand at a local eatery. I enjoyed the collegial atmosphere of the clinic. Nobody questioned the value of my work. And I was getting paid.

Being the one coming home to the kids, in time for dinner, gave me a new view of domestic chores. I came to greatly appreciate two things in particular: a path cleared from the front door to the kitchen, and a meal of any kind on the table. These days, on the three days a week that I stay home, I strive for that minimum, and some days I achieve it.

In many ways, Pete's stay at home wasn't comparable to my own. His was for a defined period of time, a matter of weeks. Mine is indefinite, making it more difficult to keep perspective. And postponing a career for a decade or two obviously has greater implications than a brief leave from work.

Still, those ten weeks gave him an empathy for stay-at-home parents that only time in the trenches can.

(Originally posted at www.freshmd.com)

Friday, July 18, 2008

Bees and Birds

“Douche bag!” My tween son hurls at his brother in the car on the way to a picnic.

“What was that?” I counter.

“Douche bag.” He returns sheepishly.

“Do you know what a douche bag is?”

“No, not really.” Will replies.

“Well let me tell you.”

And so continues our snippets of car talk. One would think that talking about sex and sexual matters would come easily for a pediatrician. Conversations about sexual matters and children are a daily occurrence in my practice. Yet a different element exists when I am trying to convey information about sex to my own children.

Trends in our family would suggest that there are some universal truths about sex education. The first is that the topics my children seen to have the most questions about aren’t covered widely in any book I know about. We’ve covered the basics – mostly in the car – about where babies come from and the real words for male and female anatomy. Sometimes it is all I can do to stay on the road. Then there are these other topics like defining a douche bag or masturbation. One time after an Oprah episode my eldest wanted to know what a pedophile was. Okay, where do I begin?

The second universal truth is that I am my sons’ go to girl for information. I am the token female in our family and it is my job to educate them about the female gender. Yeah, right. My job has globalized into ISM specialist or Information about Sexual Matters specialist. As I strive to keep these lines of communication open and honest, I am having epiphanies of understanding for all the parents who struggle with these topics. At one point I had aspirations of writing a coaching guide for mothers of boys to tackle some of these topics. I bought as many books about puberty and boys as I could find on Amazon.com. If I educated myself, I might be able to educate others, right? As the project sits stagnant on my bookshelf, the books have provided practical punctuation for Will’s sexual education and fodder for more conversations to come.

Lastly the universe has decided that we will have these conversations whenever and wherever. Car, movie theater, restaurants. No place is excluded. As a new parent, I assumed that “the talk” would take place in the privacy of our home. When my boys ask questions, they seem out of context because 90% take place out of our house. The silver lining to this truth is that the conversations are usually short – literally snippets – and ongoing. This is a key concept I try to share with families in my practice. The talk really should be an ongoing thread woven into daily life. Break off small pieces to feed your kids on a regular basis. It is less overwhelming that way.

“Sorry about the language, Mom.” Will say at the end of the picnic.

“I’m just try to teach you before someone else does.”

“I know.”

“I don’t want you to be embarrassed by a teacher or someone else’s parent. You need to know the real meaning of the words you use.”

“Thanks, Mom.” Will kisses my cheek. Mission accomplished (for today).

Thursday, July 17, 2008

DoctorMom, revisited

I've been asked about how being a doctor affects the way I'm a parent; in review, I'd have to say there are probably some things I have done differently because of my background: I probably worried less about a runny nose and productive cough when my kids were younger. I'm more annoyed than concerned about the occasional bloody nose that Youngest gets, especially after he's admitted he hasn't been taking his allergy medication. My kids have known anatomical terms for their most private parts since before they could talk, and the "toy" medical kit they used to use contained the stethoscope I received when I was a medical student. And dinner table conversations are as likely to include a discourse on why cocaine can lead to a stroke (even in first time users) as they are to include a review of the school day.

More important, I think, is the question about how being a mom has affected the way I practice medicine. I see a great deal of "carry-over" as I interact with my patients. See the way that lady with Alzheimer's disease grabs my hand and won't let go? In residency we learn about "frontal releasing signs" as an indication of deterioration of the brain; as I speak with families I can describe how this is similar to the grasp that an infant has, because I've experienced that same grasp when my babies were born. Similar to the way I don't shy away from explaining the concept of "you get benefits out of something proportional to the effort you put into it" to my kids, I'm not afraid to tell a patient who has refused to participate in the home program component of physical therapy that I'm not surprised that he hasn't seen any lasting benefits. And (I know that this is not at all politically correct) if one of my patients has shared with me fears or concerns about the future, especially as it relates to the illness I treat her for, I'm not hesitant to give her a hug at the end of the visit any more than I would hesitate to hug one of my children after they've shared their most recent fear or worry.

I'd like to believe that being a doctor has made me a better parent in many way; at the same time, I'd like to believe that being a parent has made me a better doctor.

Have any of you experienced similar experiences with your patients?


Tuesday, July 15, 2008


I've written before about the decision of female physicians to have a child early in their career versus a child late in their career, but there's a third option I've noticed more and more female physicians seem to be choosing: no kids.

In some ways, this makes sense. We've spend four years on undergraduate training, four years in medical school, 3-5 years in residency, then maybe a fellowship on top of that. After all that, shouldn't we want to focus on our careers? Did we really spend a quarter million dollars on our education just to work reduced hours to spend more time with the kids? We could have been a mother for free.

In my residency program, many of the female attendings have chosen to be child-free. When asked why, they gave the following reasons:

"I wanted to be able to retire early."

"I thought I could either be a good doctor or a good mother, but not both. So I chose to be a good doctor."

"Kids are too much responsibility. I'd rather be a godparent or an aunt."

"I don't like kids that much."

"I didn't want to ruin my life."

A lot of people seem to be enamored with the concept of DINK. DINK is an acronym that stands for Double Income No Kids. As another resident recently remarked to me, a pair of DINK physicians really have it made. They can have a huge expensive house, they could spend their afternoons playing golf, their weekends at the spa, and their nights bathing in gold amulets (I guess I don't really know what rich people do in their leisure time). They could retire at 50.

Of course, I've always wanted kids so I see things differently. I don't see the point of a big house if I'm not going to fill it up with kids. The reason I want money is so I have it to spend on my kids. And what will I do after retirement if I don't have grandchildren to play with?

Monday, July 14, 2008

Guest Post: The Life of Doctor Mom

ok, so maybe i am crazy. i have never blogged before, but am willing to give it a shot.

i am a pediatrician, mother of 7 children, ages 1 to 18 years and a full time faculty member of an academic university. is that redundant? i really don't have time for this, but feel drawn to speak up on this life of ours. the life of Doctor Mom.

My father told me it would be too hard for me, that I shouldn't sacrifice so much or work so hard. i don't think he meant to be discouraging, he was just scared. still, if my brothers wanted to be the doctor of the family, they would've gotten hi fives and pats on the back too. luckily they are both lawyers, that leaves me, the official black sheep.

my kids are gems, i love every single one of them. my husband and i are like that, we just look at them and smile or sneak a shared giggle behind their backs when they act up, which is frequently enough. they aren't angels, but they are good.

what really breaks my heart is all the patients in my practice. they struggle with so much; poverty, singleness, young parents, joblessness. working in a large urban practice i see more than i'd like of child abuse, mental illness, addictions. i love all these families too, but my husband says i'm not allowed to bring any more children home. he can't take the stress.

i feel the biggest problem we women physicians face is lack of time. if i could only survive on 4 hours of sleep a night, i would be on top of everything. maybe? my bills are stacked sky high in my dining room, my living room is a mess again, the kids watch too much T.V. and we don't eat home cooked meals (unless my husband makes them!) well, i cried when i read the blog from the daughter of an OB/GYN, it made my decision to be a doctor ok too. I also have an 18 year old daughter going off to college, and i'm so proud of her.

p.s. - my baby just crawled on the dining room table to get my attention and kissed my left hand. never forget, doctor moms, what life is really about!

peace, drmamamaria7

Saturday, July 12, 2008

Mr. Mom?

It's July, and that means it is time for my annual 2 week camping trip on Labor and Delivery. Every year, my partner, OtherDoc, takes a two week July vacation, and I take a two week hiatus from sanity. I'd like to think that I'm a fairly busy physician on my own, but when I see 30 patients in a day, OtherDoc sees 60 patients in a day. While I do 10-20 deliveries in an average month, he does 30-40. Put us both together, and it is a recipe for sleepless nights, crazy days, and very little time spent at home. Last year I got so busy, it pushed me over the brink from gestational hypertension to full on preeclampsia, and my own physician had to ferret me out on labor and delivery at 9 pm to tell me to wise up and go home for bed rest. (I delivered 2 days later.)

This year has been no exception. I've delivered 8 babies since Monday evening, and have spent early morning, noon, and night with patients. Mr. Whoo has been left to defend the home front, and, in his usual superstar fashion, he has handled everything in a superb way. CindyLou, my four year old daughter, was diagnosed with strep throat this week, and Mr. Whoo was elected to stay home while I delivered another 3 children. When I got home, I was amazed. The house was clean, the laundry was done, dinner was cooking, and CindyLou was feeling much better. Now, granted, he did just have the 4 year old (I took the baby to daycare for quarantine purposes), and I'm quite certain that CindyLou spent the day plugged in to the Disney channel, but *still* it was amazing. It sparked a conversation about perhaps having Mr. Whoo stay home with the children, full time.

I consider myself more than a little...traditional, if you will. I chose to take my husband's name when we got married, and feminist issues have always been more remote on my radar. (Not that I'm *down with women* or anything, but I just don't have a bee in my bonnet about such things.) Since leaving residency, financially, I am the bread-winner, but Mr. Whoo is also a professional with a good job and great benefits. A few years ago, we would have never considered this scenario, but now it seems a viable option. We've been struggling, with both of us working, to keep above water with the household chores, cooking, shopping, laundry, and keeping the children cared for, fed, and entertained. It makes sense, financially and personally, to seriously consider this option; especially as I look for better job opportunities. I don't think we could sustain it long term, because Mr. Whoo has professional aspirations, as well. He is preparing to pursue another degree to further his career, but, for now, it seems the time may be right. I'm pretty sure that Mr. Whoo won't try to feed the baby chili for lunch, and "girl's night" at the male strip club is definitely out, but I do worry that it may hurt his male pride a bit to be the stay-at-home parent. Any advice out there from those of you that have chosen this path?

Thursday, July 10, 2008

Tuesday Hunger

In the morning, I’m a hungry mother. My eyes take in her profile, her impossibly long eyelashes, the outline of her lips. Drinking in every detail of this face that is more beautiful to me than my childless brain could dream. I get ready for work, taking intermittent breaks to focus on her. This face that I will only get to see this morning.

Even if it means I’ll be running late, I want to walk her to school. JP tries to help me get on my way, offering to walk her, but I won’t have it. This is my time. This morning is my walk.

We walk (and jog and skip) to school and as much as my mind is on the time and having to go off to work soon, I push it aside to be present in this moment. We might stop to admire an overhead plane. Watch the birds swooping from tree to tree. And at the door, our kiss and hug means more than it usually does. I linger. I squeeze a little tighter. The pause bringing her cheek into my lips – a deliberate moment filled with my hopes that her day is a good one.

Too quickly, our good-bye is over and she is already running to see her friends. I watch the back of her and quietly accept my retreat.

During the day I am a manic doctor/teacher/mentor. Rolling along at a mad clip: too many things to do, so many competing thoughts. Throwing on these various hats as I sequentially cross the different thresholds. First a teacher/doctor, then an administrator/mentor, then an employee, then a clinic physician. There’s not much spare time to think about how her day’s going. But when I see a toddler in the waiting room or children playing outside as I drive to campus, hoping to steal some moments before class to finish my assigned reading, the missing floods me.

I arrive on campus to find myself in a sea of the very young. The undergraduates look like children to me, my pregnant body belying my age and clearly separating me from them. Conspicuous. We’re in different worlds. I can’t even remember that age of self-indulgence, yet together we wade in the school waters of a campus Starbucks, caffeine-fixes and studying. My watch says it’s time for her to be picked up by JP. I wonder what she’s done today, the artwork left on top of the cubby, whether she’s coming home in different clothes than she left in. I think about calling.

In class, I’m a hungry student. I hang off the words deliberately spoken by my trim, brilliant professor. It’s a small doctoral-level seminar but she doesn’t often meet my eyes, which might bother me in a different place, a different time, yet, it doesn’t now. For the wisdom and perspective she’s delivering is feeding my mind. I’m wholly engaged and captivated by the material. Soaring expansiveness fills me as I am lost in thoughts of identity and adult development. It’s a quiet excitement filled with stored potential. Potential that bears the snapping promise of fireworks to light the nighttime skies.

On the drive home, in the settling of my mind rhythms, again I think to my family and the absence of me. I need loud music in the background. I need green lights. I need to be home, in the embrace of my husband and my home. I need to see my daughter in the light of the next morning. Breathlessly, I await her.

Hungry again, I wait.

Tuesday, July 8, 2008

Guest Post: A comment from a daughter

This was left in our comments section. We think it is worth sharing.

Being the 18-year-old daughter of an OB-GYN about to leave for college...I want to tell you all something, and I hope that it will mean something to you. Whether you forget it, remember it, hate it so much that you yell at me in comments afterward, or love it so much that you post it on your refrigerator, I think it just needs to be said. I am terribly sorry for intruding on this site, and I do not remember even exactly how I found it. Still, I am glad that I did for the sake of this message. I only wish I could post it on the main page, however intrusive that may be, and that you all might understand the message even if I don't articulate very well (and I know I often do not when I try to sort through my thoughts). The OB-GYN in my family is my dad...but I think that it has less to do with which parent is the doctor in the family and more to do with how much we, the children, can't help but love our parents.

My dad was the head of the department at a hospital down here for 7 years. He worked even more then than now. He had wanted kids for years but waited because my mom wanted to work on her career a little more and settle (she was a bit wild and decided to quit her job [special ed teacher] after my older brother [1st baby] was born.)

Growing up, I don't remember much time with him. ...but I remember that we'd lovingly pack up a little of everything we had for dinner and put it on a plate, cover it in plastic wrap, and only then would we serve ourselves the food, so that he could "share" dinner with us, even though some nights he wouldn't be home until long after we were sleeping.

I remember him forgoing eating that dinner we saved some nights--no matter how hungry he was after being held late, or even if he only got there by rushing home for a short stop while he was on-call--so that he could give us three our night-time baths and tuck us in (we all fit in one bed back then, WITH him to tell us a story of growing up so far away in NYC up north, of all places!)

I remember that waiting eagerly for the time when his one day off a week after his on-call night would be "my" day, and I could spend time with him one-on-one. (We took turns, though I admit I was impatient for mine.)

I remember throwing tantrums and getting upset, with him yelling and me yelling...and looking back on it, I realize that I was just a little kid being a little kid, and he was just my exasperated father trying to get me to behave after a 36-hour day of being on-call and scared for my brother with one of his famous, crazy, one-oh-six-degree-Fahrenheit-breaking-point fevers keeping him worried while some poor mother cursed at him while birthing her baby and apologized afterward, crying and laughing, saying she didn't mean it while hugging a wriggling red baby with silly hair.

I remember eating a snack at 5PM and taking my shower early when I was just a little bit older to hold myself over while we waited for him to get home at 8PM before eating dinner and rushing off to bed.

I remember my dad taking time off work to come meet up with us for a week of vacation up north to visit some family. Then he’d have to fly back for work, spawning memories of the miserable, lonely phone calls we and my mother had with him while we were driving back, visiting more family all the way down the coast back to home.

I remember my dad getting in his scrubs to take us to the doctor and explaining everything he discussed with said doctor to us in words we could understand--whether it was the optometrist, the pediatrician, or the radiologist, respectively.

I remember crying because I thought my dad couldn't make it to my award ceremony, spelling bee, or school play; I also remember various feelings of relief, satisfaction, and sometimes more crying when my mom would video tape it and I'd watch it with him later, or when I'd see him rush in--still in scrubs--from the back in the middle of the competition, or when my teachers snuck him in backstage even though I had already calmed down because they knew I'd be so relieved and happy that he had made it after all.

I see now that my dad is overworked, overstressed, doesn't exercise well enough (not that he has much time to hit the gym, with my grandmother with Alzheimer's living with us and also requiring tons of care), and that he has always, always been there for me, loved me with all his heart (and these things count for big-brother and little-sister, too!), and has always wished he could have even more time with all of us (and still does, especially with my brother away at college).

My dad works a hard and difficult job with terrible hours because he feels it's his calling. Even when it's very difficult, there's a certain joy in it for him, in the miracle, as I'm sure you all understand. His partners are also loving parents with the same kinds of challenges of having families and careers--and all but two of the six others are women, a mother/doctor group may be interested to hear. However, I also realize that my dad works so hard also because...he loves us. Not only is he giving other people the chance to have the wonders he has, but the hard work he does makes sure that my mother can care for us and her slowly dying mother with Alzheimer's, despite those difficulties (our other grandma also lives with us, but is perfectly sound of mind, if not of eyesight). He keeps food on our table so, though things with insurance companies have made things more difficult over the years, we have never worried about food as many Americans now do--including ones nearby, ones in my school, or friends that I visit. We have never wanted for clothes to wear, a place to live, or even "extras" like a second car to drive--meaning we never had to walk the just-over-a-mile road to our school, but that we could go by car (since we're too close for bus). We have the luxury of a really cool PS2 that was an incredible gift for the three of us years ago and still serves us remarkably well for its generous age--not to mention an assortment of games we've "collected" through the years; I might add that those came mostly from birthday and holiday gifts from "Mom and Dad" that I'm sure my parents bought with the money my Dad works hard to earn.

I've lived a very privileged life full of experience and love, and I feel blessed to have had both of my parents. They are strong people who have raised me remarkably well, so I feel I have the great advantages of knowing right from wrong, the importance of learning and respect for others, and the much-forgotten value of courtesy and good manners. (And that those last two count even when things are bad or you're in a bad mood. We're all only human, but so's everyone else. Then again, I’m sure he sometimes wishes his patients taught their children that way, or lived it themselves, too...)

On behalf of children everywhere with doctor parents who worry, fret, and guilt themselves over the time they have to spend apart from their children...I want you to know that we love you, and even if it's hard when we're little to understand what you do, or why you're gone so long sometimes (though we tend to vaguely grasp even then the idea that "work" is very hard and busy and keeps you away even though you love us very much and wish all the time that you were here with us), we're proud of you and love you very much. We do our best to understand and accept these struggles with you, and we see better while looking back from older ages all of the sacrifices and difficulties you've endured for us, and just how much you've always loved us--and at all ages young to old, we love to hear you say it on nights when you're around to tuck us into bed.

Monday, July 7, 2008

Second generation

I'm in a somewhat unique position in that not only am I a doctor-in-training with a daughter, but I am also the daughter of a former doctor-in-training.

My mother returned to medical school when I was three years old, living out a dream she had held for the last ten years as she taught biology to high school students and then became a stay at home mom after I was born. Unfortunately, the dream didn’t include her marriage falling apart a year later, turning her into a single mother.

I don’t have many memories from before my mother went back to school. As long as I can remember, I was always the kid who had to stay at the afterschool program or get picked up by a babysitter. I hated the afterschool programs--I always had one eye on the door, waiting for my mother to show up. And even on weekends, I couldn’t count on having her to myself, although I did have fun when she brought me to work with her on Saturday mornings.

Residency was really rough for us. Due to all the late nights and overnights and moonlighting for extra cash, we had to hire a live-in nanny. The nanny moved into my bedroom and I moved into my mother's bedroom. I really adored my nanny (who coincidentally had the same first name as my mother), and that was a good thing since she was the adult I spent the most time with.

My mother and I were always struggling to spend more time together. When I was in day camp during the summer, one day she sneaked out of work early to surprise me and bring me home. I was overjoyed. But as soon as we got home, someone noticed she wasn’t at work and called her to return. Back to camp I went.

For these reasons, I’m glad that my own daughter won’t remember my residency days, even though I know it’s been hard for her. On the first day I went back to work from my maternity leave, I said to my husband, "She has no idea that her whole little world is going to be ripped apart..." Every day when I leave in the morning, she reaches out for me and cries. And I think to myself, "What kind of mother am I to leave her like this?" But when I go to work, I’m earning the money that pays the rent and building a career that hopefully someday she’ll be proud of.

I'm not going to lie and say that 6-year-old me wouldn't have been preferred that my mother stayed home all day and spent every minute of her time with me. And I won't tell you that my mother doesn't sometimes say she regrets going back to school and missing those early years with me. But we are very close now and I think having so much time apart made us closer. The little time we spent together was that much more special.

And even though she wasn't there with a homemade bologna sandwich every day when I got home from school, on the evenings that she was home, I got to crawl into bed with her and sleep there all night long.

Sunday, July 6, 2008

Contributions to my career

As working mothers, we often focus on how we can manage to not allow our "with-kid(s)" status to affect our work. We overcompensate to prove we do as much work as the next *man* and we play ourselves into guilt cycles if we are either away from work or away from our kids (which is the case almost constantly).

I say, baloney. Being in medical school and residency has taught me much about medicine; however, being a mother has taught me a lot about myself. And that has furthered my ability as a physician far more than I ever expected. I have, therefore, decided to make a list of all the things I have learned by being a mother, which have made me a better doctor:

1) I recognize a temper tantrum for what it is, whether it comes from a child or an adult.

2) I realize that I may make good decisions that are not popular. I don't need to apologize for them.

3) If I subscribe to the "if you want something done right, do it yourself" adage, I will be doing everything for everyone all of the time. Then by definition, no one else will never learn to do it right because they will have no experience.

4) My daughter is being raised to be unapologetically bright without the influence of gender stereotypes. I should be no different.

5) Consistency is a vital skill.

6) Hand-washing must be frequent and thorough. This may seem obvious to anyone in medicine, but 2 kids with gastroenteritis brings this issue home with a vengeance.

7) I leave work at the end of the day only to begin the even more difficult job of managing kids and a household. So does my husband. We are partners after all, and our relative value units have to be equal (we have a joint checking account). If I expect him to pull down his share at home, I have to pull down my share at work.

8) My life is crazy enough right now, I can't imagine how empty I'll feel once my beautiful kids go off to college. I appreciate that I have this great career of mine.

Wednesday, July 2, 2008

I want to be a homer...

My daughter is 3 years old and in preschool. The class is split into those who go home after lunch "homers" and those that take a nap after lunch, "nappers". She started there when she was 2 and has always been a 'napper'.

We just came back from vacation, I was tucking her in bed and wanted to remind her that tomorrow was a school day. She says to me " Mommy, I don't mind going to school but what I really want is to be a 'homer'. " My heart sank. I try my best to make her wishes come true. I take days off when there's a field trip. I rush home when she says 'come early'. I dawdle in the mornings when she's feeling lazy...but being a homer...there's no way I can pick her up at 1pm...(I have clinic every afternoon). My mind flirts with ideas of switching - maybe I could work fewer days, maybe I should just work mornings and go completely part-time!

I might even consider any of the above options if it would be the end of the guilt. The reality is there will likely always be requests that I can't fulfill...the answer I think lies in my ability to get through the moment, listen to a pep talk from my spouse and hopefully see the big picture in the morning.

...for now, my 3 year old with remain a napper. Maybe I'll take an afternoon off next week and surprise her.

Tuesday, July 1, 2008

Guest Post: Cry

“Don’t EVER let them see you cry. Not the attendings, and NEVER the nurses.....This will make you look weak and they will walk all over you.” This is what my chief resident told me on my first night of call as an OB/GYN intern 7 years ago today. She meant well, but since she was the main person inducing my tears, I mainly just found her to be mean. I grew to respect her as the year went passed. I’ve thought of her advice many times since, but I never learned to control my tears.

I cried when I was 24 weeks pregnant and had to deliver a patient at 24 weeks, then later pronounce its time of death.

I cried my first day back from maternity leave. The first shift was a nasty call as a 3rd year resident. I didn’t get to see my baby for 36 hours. Luckily, a wise attending pulled me aside and told me she had cried too with each baby. That it would get easier, and it did. I held him and cried for an hour when I got home that next day.

I cried when my son was 2 months old and diagnosed with an autosomal recessive genetic disorder. I was told he would be blind (he’s not) and I should not have more children (I haven’t). I was on call that night after the doctor's visit. I did 3 ectopics. I cried through each one.

I cried once when my vacation got cancelled as an intern (that one, of course, is a pretty lame reason).

I always cry when I watch girl movies.

I still shed a tear when the dad cries at delivery. (anyone else?)

I cried tears of relief when I passed my oral boards.

I cried when I had to tell a friend/patient she had yet another missed AB.

I cried when Charlie died (on Lost).

I cried on my last day of my OB/GYN rotation as a med student. I couldn’t believe how much I enjoyed it and how much I would miss the service. I realized then, that despite being president of the family practice club, I had a new calling. The most amazingly wonderful job in the world. So, sorry Chief, I have let them see me cry. I‘m not weak. I just still have a heart.

-An OB/GYN in Nashville.