Wednesday, September 17, 2008

Secret Weapon

I have a secret weapon – not a bat mobile, not a web shot from my inner wrist, not an iron suit – think domestic secret weapon.

It’s my crock-pot and in fifteen minutes of prep time – I can create the illusion of having slaved in the kitchen for the last ten hours. Magically this appliance takes raw meat and vegetables and creates a main dish, a side and gravy. This satisfies my meat and potato men (separate sides of the plate, please) and my casserole (one dish, less clean-up) mentality.

I’ve heard the concerns about crock pot cooking: the appliance doesn’t cook hot enough to be safe. What if it malfunctions (which has happened and we ordered take-out that night)? What if it sets off a fire when I’m not home? I’m willing to take the risks as I do with all the other appliances plugged into my house. Thankfully no one has gotten ill from one of my crock-pot adventures, and I have yet to burn the house down.

I own about fifteen slow cooking cookbooks, and always looking for a new take on my stainless steel wonder. One of my family’s favorites is pork BBQ. It is stupidly simple and can spawn multiple varieties. One pork butt roast with bone intact (don’t know why the bone matters but it does). Put the roast in the slow cooker ten hours in advance of dinnertime. If I remember, I try to put a liner in the cooker to ease my clean-up. Pour one bottle of BBQ sauce over the top and cook on low for 10+ hours. I keep this one very simple with just meat – but I usually add vegetables to my other slow cooker recipes such as pot roast, chicken and dumplings, (bastardized) chicken cacciatore, or beef stew.

At the end of cooking time (and this works well overnight for lunch, too), all the meat falls off the bone into juicy, tangy ribbons of pork which are easily draped over a sandwich roll. I like it by itself with vinegar BBQ sauce. Throw together some salad, fruit or baked beans, and I have a meal. Turkey or chicken can be substituted for less time with good results.

The best part ….the whole house smells like I’ve cooked all day. Heroically I can serve dinner at 6PM sharp with clean-up by 7. Not faster than a speeding bullet but according to 19th century French chef and author Urbain Dubois, "the ambition of every good cook must be to make something very good with the fewest possible ingredients."

time management 101 (minus 98)

There are only 3 things I do for my time management:

I make sure I keep track all the things I HAVE to accomplish that day.

I come in early the next day if I have left anything behind.

I take lunch behind my desk.

That's my imperfect scheme, but those three things get me home in time to have dinner with my kids, and that's what I think is important!

Monday, September 15, 2008

Gap tears

I started my fall shopping over the last couple weeks. This year’s gap hoodie is size 5T. It dawned on me, that very soon I will be shopping at Gap kids and not baby Gap. This is blowing my mind right now. We attended a private school fair recently. Everytime I answered “Kindergarten” to the question “What grade will your child be in next year?” it got a little harder to hold back the tears.

Time is going by so fast, I just want to treasure every second. I don’t know if this is because he’s my only child that I’m feeling this so strongly, or perhaps because our journey for number #2 has been such a long one. Perhaps, everyone feels this way and I’m just more vocal about it. I’m hoping that perhaps I’m “pre-grieving”. When my grandpa died, about a month before he passed I had a day where I realized the end was near. I mourned for a week, but when the actual funeral came, I was at peace. So hopefully by the time school year rolls around next fall I will be at peace with it… otherwise prepare for multiple teary posts.

Friday, September 12, 2008

Next Topic Day: Time Management

On Wednesday, September 17, we'll be writing posts that have to do with Time Management. A frequent question that has been posed on this blog by our contributors and readers alike, is: how to juggle it all? Aside from being cloned, how to manage mothering, a demanding profession and doing everything that needs to be done in a day's time, preferably while maintaining our sanity? What has worked for us? What hasn't? What do we still struggle with?

We hope this Topic Day can provide an exchange of ideas that can help us all. Please join us and send in your tips/solutions/stories to mothersinmedicine AT gmail DOT com by Tuesday, September 16 to be included.

If you missed our last Topic Day where we shared our labor and delivery stories, you can see them here.

Thursday, September 11, 2008

The high price of motherhood

My little daughter takes violin lessons, typically on Saturdays. This Saturday, we had a conflict, so I took the only other spot available, a 3:00 pm Wednesday lesson. I don't get off work that early, of course, so I figure I will quickly take her and then bring her back to work with me.

The workday was packed. I wanted to back out of this cockamamie scheme that I had somehow let myself into. But I just went ahead and did it. I had heartburn and a mild headache by the time I got back. Having my daughter at work with me proved very inefficient, but by 6:00, we were set to go home, with a little residual work left for the following morning (I came in at 6 am this morning to catch up).

I don't think I have any wisdom to share. If there was a simple answer on how to have a medical career and be a mother, we wouldn't have stress or angst. I think that I have two of the most wonderful kids in the whole world, and I absolutely cherish them and thank God for them. I also have a fantastic career that I love. My payment is stress, both physical and mental. It's also the guilt I feel when I can't devote the time to my career that I would otherwise before I had kids. It's the grating knowledge that others may either resent me and/or think less of me when I have to put my kids first. But these are all payments I am willing to make, because my life is full and beautiful. Nothing truly great comes without sacrifice.

Anyway, nothing this week will top my experience yesterday at work when, during an intense conversation with one of the general surgeons about his patient's biopsy results, Sophie gets right in my face and says "MOMMY, I have to POOP! I have to poop REALLY BAD! (I was trying my best to shush her) Really, I'm NOT trickin' ya! I have to POOP REALLY BAD! MOM-MY! I have to POOOOOP!!!"

Don't worry, we made it.

Monday, September 8, 2008

This looks like more fun than it is

I remember in the last few weeks of my pregnancy, it took every ounce of my strength to drag myself to work every morning, between being sleep deprived and having pain in every joint that was capable of feeling pain. I hung in there because my maternity leave was finite and I wanted to spend every moment of it with my baby. So that meant coming in to work until the bitter end.

But it turned out I wasn't the most miserable person around. In fact, it never even occurred to me that there might be people out there who were actually jealous of me and my thirty-pound belly.

I discovered the truth one evening, while I was sitting in the office I shared with my swingin' single male co-resident. We were complaining about our workload and suddenly he blurted out:

"I wish I were pregnant."

I had never been so shocked. Immediately, a range of angry replies ran through my head: What part of pregnancy would you like? Would you like to carry 30 extra pounds around with you everywhere you go? Would you like to have to wake up 10 times a night to pee? Or would you just like to go through a painful labor possible ending in a major abdominal surgery? What part of being pregnant appeals to you the most??

I didn't say any of that though. My reply was, "You don't really mean that."

He quickly said, "You're right, I don't."

Of course, what he really meant was that he wanted to have a six week maternity leave. Except what he really meant was that he wanted six weeks in Bermuda.

To many people who have never cared for a newborn before, maternity leave seems like just that: a vacation. And those who cover for you when you're gone get resentful that they have to work harder so that you get a six week vacation, while all they get is a measly 3-4 weeks.

Comments like the above fed into the extreme guilt I had surrounding my maternity leave. When I came back to work, I was afraid to even talk to anyone for months because I assumed all the other residents hated me for getting a "paid vacation".

And even though it's been over a year since I returned from leave, I still haven't completely left those feelings behind.

Sunday, September 7, 2008

"Doctors Wanted - No Women Need Apply" - NOT!

I could browse this site for hours: the N.I.H./National Library of Medicine website called Changing the Face of Medicine, which celebrates the lives of women physicians in America.

Any time I get a little discouraged or feel a little fatigued about working my two jobs - nine or more hours in the O.R., followed by a commute home directly into the next task, food preparation for the evening meal and after-dinner homework/music/general kid-help - I look up stories of women who had it MUCH HARDER than I do and try to give myself a little wake-up call. I stop whining right away.

Here are just a few of the many amazing stories that have inspired me:

Dr. Susan La Fleche Picotte, born in 1865, was the first Native American woman in the United States to receive a medical degree. She was 24 years old. She was also the first person to receive federal aid for professional education. The M.D. program at the Women's Medical College of Pennsylvania was a three-year program; she graduated after two years at the top of her class. She had been inspired as a child to study medicine by the death of a Native American woman after the local white doctor refused to provide care for her. In 1894 she married Henry Picotte; they had two sons. She had a busy general practice serving both white and non-white patients. Two years before her death in 1913 she opened a hospital in the reservation town of Walthill, Nebraska, achieving a lifelong dream.

Dr. Elizabeth D. A. Magnus Cohen was the first woman licensed to practice medicine in Louisiana. The NLM site relates, "While she was still in medical school, a New Orleans Bee editorial on July 3, 1853, had labeled the idea of a female physician treating male patients as incongruous and improper. In 1898, an editorial in the Journal of the American Medical Association blamed women physicians for the declines in salaries and prestige of the medical profession. Eventually, medical schools began refusing to admit women." Dr. Cohen recounts that as a surgeon she was called at least once or twice every single night before dawn during her thirty-year practice from 1857-1887. Other doctors apparently referred to her as a "lucky hand" in tough cases. She was married and had five children, though only one lived to adulthood.

Dr. Sarah Read Adamson Dolley was the first woman to complete a hospital intership, in 1852. Her interest in medicine was sparked by a physiology book given to her by her teacher, Graceanna Lewis, to read at home. She practiced OB/gyn and ran a medical practice with her husband, with whom she had two children, one of whom died in childhood. "Her vivid correspondence documents her success in creating a solo practice after the death of her practice partner—her husband. They also reveal her anguish over how to support her son, pay for his education (he, too, became a physician), and how to overcome the resistance of her male colleagues. But her letters reveal that in her rise to success, nothing was easy, especially without a role model to guide her."

Dr. Halle Tanner Dillon Johnson was the first woman of any ethnicity to be a board-certified physician in the state of Alabama. She was already married and a mother when she began her medical studies and in 1891 earned her medical degree from the Women's Medical College of Pennsylvania with honors. While "southern newspapers had scoffed at the idea of a black woman even applying to take the [board] exam," in that same year the New York Times took note of her success in passing the grueling ten-day Alabama State Medical Examination. Alas, her career was brief. She died of childbirth complications on April 26, 1901.

Finally, though I don't think she was a mother as well as a physician, I want to honor Dr. Elizabeth Ann Grier, the first African-American woman licensed to practice medicine in Georgia. She was an emancipated slave who alternated every year of her medical education with a year of picking cotton in order to pay for her training. "When I saw colored women doing all the work in cases of accouchement [childbirth]," she said, "and all the fee going to some white doctor who merely looked on, I asked myself why should I not get the fee myself. For this purpose I have qualified. I went to Philadelphia, studied medicine hard, procured my degree, and have come back to Atlanta, where I have lived all my life, to practice my profession." Sadly, she died in 1902 after practicing for only a few years.

It's stories like these that let help keep me going, putting one foot in front the other and telling myself, "You can do this. You totally can." I think we have to keep passing on stories like these - to our students, our colleagues, our children, ourselves.

Saturday, September 6, 2008

watching from the sidelines

First swim lessons this weekend for Just Four. As a former lifeguard, current mother and pediatrician, one would think that I could have taught her some swimming basics. But despite our best intentions and her inquisitive nature, my daughter has a hard time learning from her parents. She knows Dr Mommy is the best at putting on band-aids. And that daddy can rock out on the guitar. However, our teacher-centered little girl who is frequently found to be instructing her stuffed animals in all of life's lessons, appears to learn best from Other People. We struggled with which class to choose, one in which we parents could wade in the water too versus one in which we were banished to the sidelines (instructor to parents "Step away from the pool"). Choosing the latter proved to be a wise move, as she made us proud, nervously saying Goodbye and then completing her first lesson, bubbles, floating, gliding with an occasional wave to Dr Mommy, who, behind a glass wall was watching her daughter learn and grow on her own. Needing me but not needing me. Oh, yes, and my needing her.


Mamapop had a great discussion Thursday about feminism, and how it applies to politics, specifically Sarah Palin. Feminist is not one of the labels I apply to myself (like juliaink). Just don’t consider myself a pioneer in moving the cause of women forward. I also don’t tag myself as a political animal. However, this election has me fired up because I feel that the items the media has picked up and discussed are issues in my back yard.

As women in medicine and specifically mothers in medicine, we have a unique perspective. My occupation is 24/7. I share call with other physicians, now, although I was once a solo practitioner. The ownership part of my practice is still there seven days a week and requires maintenance whether it is employee reviews I need to write, maintenance of the facilities or just a late night security call. Being a physician is a 24/7 job whether I’m on call or not – and I suspect it may be that way for my fellow MIM writers. Have you fielded a phone call from a worried neighbor or family member because you have MD or DO (or RN, PA, NP) after you name?

Mothering, Fathering and Parenting are also 24/7 jobs. Even with my two healthy children, the balance is precarious and dynamic. I can only imagine what adding intense media coverage, decision making for 300+ million citizens, and overlapping passport stamps would do to my stress level. It’s not that the VP (or presidency, for that matter) job isn’t compatible with parenthood. It is. I’m not sure the job that will require 110% focus seven days a week (or at least this is what I expect out of elected leaders ) is balanceable with children that need their parents as much as 2 of the 5 Palin kids will need their parents in the coming months.

Friday, September 5, 2008

Childbearing in Surgical Residency

My intent was not to make such a serious posting, but I did not succeed.

After 8 years of surgical residency and fellowship, I am happy to report that our lives are returning to some sort of “relative normalcy.” Stress the word “relative” as most would not describe it anything close to “normal.” Life as a junior staff surgeon involves frequent call, occasional emergencies, and the ability to pick up slack for my senior partners. But my life now carries with it innumerably greater amounts of flexibility than life as a resident or fellow.

I now have a small teaching group of 2 female medical students in their first year of medical school. They “shadow” me in clinic or the operating room once a week. Although both are interested in what I do as a surgeon, inevitably they are most curious about my decisions and experiences with childbearing and family life. I tell them about training. I tell them that it is hard but that family life and motherhood are great and well worth it.

It was harder than what I tell them, especially as most of my training was before 80-hours and “80-hours” is often still theoretical in surgical training. All medical training is difficult, but surgical training is perhaps the hardest. Finding the balance between family life and work duties is hard for all surgeons, particularly for women surgeons in training.

The “ethos” of surgery remains principally masculine and rigid. Surgeons are supposed to be particularly strong, not to complain, and to go along with the “status quo”. While this may sound backward and negative, paradoxically in many circumstances I find the first two of these qualities admirable, and I still believe surgery to be one of the most exciting and rewarding career paths that anyone could choose.

As most parents will testify, childbearing is one of the less challenging aspects of parenting. But decisions around childbearing and the time with your newborn are important shaping experiences.

The concept or image of a pregnant surgeon, whether or not in training, is still a foreign one to quite a number of surgeons, some of whom feel free to share their opinions. The decision and process of pregnancy for women residents (I suspect in a number of medical fields) produces anxiety and (both subtle and overt) comments. I have seen female residents leave surgical residency either for another medical specialty or leave medicine entirely as a result of issues surrounding childbearing. Two of my female resident colleagues “decided” to return to work only a few weeks after giving birth because one had been placed on bedrest before giving birth and the other was told two weeks was all the residency program could bear. Female residents that take full time for maternity leave often “owe” additional months (as it might be in other training programs) but also often suffer palpable resentment from fellow residents.

This is, in part, because typically the decision for a female surgical resident to have a child directly impacts the entire training system. And surgery, worse than most other medical sub-specialties, has not found solutions to address these issues. Most surgical training programs suffer from more limited people-power. When one person is not performing optimally or is absent for any reason, the entire team feels it. The call schedule might change from every 3rd night to every 2nd (of course, illegal under current regulations). This issue is perhaps the worst in some of the sub-specialties where the entire training program is composed of a handful of individuals. Interestingly, several of my female friends who have entered small private practices after training also experience similar pressures as childbearing would impact their partners' lives significantly.

Issues of maternity leave, parental leave, and time for other parenting duties in most residency training programs have not been traditionally prioritized. Not surprisingly, fields like surgery which have been slowest to find solutions and to transform their ethos feel much-needed pressure to start making changes -- as women now make up over half of graduating medical school students nationwide.

Personally, I “timed it” well, having my daughter during my years in research during residency. My 4-year-old daughter is beautiful, well-adjusted, and a great kid. And my husband and I have found a satisfactory parenting balance that works. I am extremely lucky, but I would like for my experience to be less of the exception.

Thursday, September 4, 2008

Shoes: the other Elephant in the Room

So. There‘s pair of $200 shoes sitting on the floor of my closet.

They are beautiful. The smell of their leather sends chills down my spine.

When I tried them on in the store, I actually felt giddy. I’ve put them on twice…. But if I wear them outside the house I can’t take them back, so I haven’t yet.

I tell my self I deserve them. All those long nights at the hospital and hard work should be rewarded. Really, I don’t need them. My closets are full. I’m blessed. Truth is: time is money. As we prepare to hopefully adopt baby # 2, I see each purchase as time. The less I spend, the more time I’ll be able to take off to spend with the new baby when it comes. (No announcements yet but I'll keep you posted.)

I own my own practice. I’m one of 4 partners. My overhead is killer. My malpractice premium alone could buy one fancy Lexus. I do well, as long as I’m working. Taking much time off leaves me seeing red for a few months. Last year when I had to take my boards, I didn’t get a paycheck for 2 months. I accept this because it gives me complete control of my schedule. My partners are great. We get along personally and professionally remarkably well. We are all moms and we cover for each other a lot. Financially though, we “eat what we kill”. We work as little or as much as we want, take equal call, and pay equal overhead. Overhead includes salary, FICA/taxes, and benefits for two dozen employees.

I try to remind my self that the more money I spend, the more I have to work, the more time I spend away from my family. So I think the other elephant in the room is money. At least for me, since I’m the breadwinner in my family. It‘s physically painful to write out a check every 3 months for $15,000 and mail it to uncle SAM. It’s hard not to also see this as time stolen away.

I was looking at everyone’s profile in our group and it seems that myself and perhaps MWAS are the only Physician’s in private practice. Is anyone else self employed? Are taxes less obvious when you’re an employee and it just gets deducted. Is malpractice less obscene when some else foots the bill?

I don’t plan to vote with my pocketbook. I actually don’t plan to vote. (My state is so red even Gore couldn't take it.) But as I said, time is money. Every dollar more I pay in taxes and malpractice is less time spent with my family. Since the Dems came a little too close to having a malpractice lawyer on the ticket, and because I am both a corportaion and nearly "rich" some have promised to increase my tax burden, twice (don't tell my staff, but we could have to cut back). So yeah, I’m eyeing the Dems with more than a little suspicion.

Gottogo. Need to return some shoes.

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.

Wednesday, September 3, 2008

Girl Bonding 101: Moving Beyond Netter

I am in a state of slow, silent, ever-evolving panic.

I just looked over at my 10-year-old daughter (soon to be 11), and for a second I saw a young woman sitting in the armchair. Or at least, a young pre-woman. Ack.

She has shot up several inches and a couple of shoe sizes this year. I feel like she goes up one Tanner stage every week or so. Her face has gradually acquired subtle, more mature angles, and let’s not even talk about the rest…

She builds sand castles at the beach and sleeps with her teddy bear. But she also notices attractive young actors or singers, and her comprehension of the nuances of flirtation is accelerating at an alarming rate. She is bubbly and all smiles and hugs one moment, irate and scowling the next, at the slightest provocation. She can still enjoy Sponge Bob, but she can also start to discuss American politics and social issues. I am amazed and thrilled and in awe and totally distressed.

I want to tell her pituitary axis: whoa! Slow down! Childhood’s short enough! But it’s useless.

It’s time to have THE TALK.

No, not that talk. We had that talk when she was eight, because the kids at school were already disseminating all sorts of sketchy information about reproduction and childbirth. I told her I was okay with her discussing reproduction and childbirth but I wanted her to have the right information – and who better than her doctor-mom to provide it, right?

Now, I am sure there are lots of people out there who can describe the “right way” and “wrong way” to handle sex education. I myself got “educated” in a bit of an unusual way. I was in a book store when I was five and saw a book entitled Where Babies Come From, or something like that, illustrated with some cartoon-like illustrations. I had been reading for about a year. I picked up the book, learned the facts of life, and, bored out of my mind, put the book back on the shelf. My mom was a little surprised, I think, when, after she expressed doubt that I actually knew about intercourse, I explained the process to her fairly accurately. It was only later that the more abstract concepts came within reach.

When my daughter asked me where babies come from, I said, “Cells, of course. Remember how I told you all our bodies are made of little, tiny things called cells? Babies start out as little clumps of cells inside their mothers and grow bigger and bigger with time. The parts of the body develop as our cells make more cells.”

That explanation satisfied her for a while, but then the inevitable came: “How do the cells get inside the mommy? And is it true that mommies push the baby out through where they pee?” That was the part the kids at school were talking about.

That was the part that made me thankful I'd hung on to my Netter Atlas of Anatomy from medical school. I sat my daughter down between my husband and me and we explained the relevant mechanics of reproduction step by step. I explained a little bit about menstrual cycles. I drew simple diagrams of female internal organs and used Netter as a supplement. Last but not least, my husband and I both expressed our personal values regarding the place of sexuality in the context of human relationships. As our daughter listened I felt proud, because she seemed to be listening so thoughtfully.

Lately, though, now that she’s a little older, she has acquired a kind of embarrassed reluctance to discuss “woman stuff.” When she was eight we could almost sense a certain pride in her at being entrusted with these more “adult” concepts. Today, however, she’d really rather not talk about them. But I feel I have to get us talking about them, not only to reinforce the idea that it’s okay for us to talk and for her to have questions, but also to make sure she doesn’t feel anxious or uncertain or ill-informed. Sometimes it seems like it's almost easier to get patients to open up about personal things.

I wanted to have the talk about menarche. I think it’s imminent at this point. But how to create a level of comfort about the subject? And to make sure we’re prepared, together, before the moment arrives? I want her to feel good about growing up, to celebrate each milestone instead of dreading or being unpleasantly surprised by it.

The other night an opportunity arose. I don’t quite remember how. But the subject came up, and I asked her if she had any questions about periods.

No,” she answered emphatically, casting her eyes down. I could almost hear her mortified mental voice asking me, Please don’t give me an awkward, long-winded lecture; please don’t start looking for “ins;” and please, whatever you do, don’t ask me if I’m sure about not having any questions.
“Are you sure?” I asked, stupidly. So predictable.

Then I started to babble. I told her she could always come to me if she felt unsure or worried about something. I told her it wasn’t at all scary to get a period if you knew what to expect. I told her I would go with her to the drug store when the time came to look at the options in terms of supplies.

Then it happened. I got my “in.”

“Actually, that’s the part I wasn’t sure about,” she said, looking up again.

“What’s that, honey?”

“The supplies part. I don’t exactly understand how they work.”

Relief! She had given me a concrete way to nurture and support her! Hallelujah! I launched into an enthused discussion - not, I hoped, an awkward, long-winded lecture - about the pros and cons of various types of supplies, demystifying the “anatomy” and mechanics of each with appropriate exhibits. I explained what I liked and didn’t like about each option.

Sometimes, whether it’s a patient or a beloved child, it can be so tough to talk about so-called “sensitive” issues. And somehow it can be much easier to be direct with total strangers. “Are you sexually active?” we ask during a comprehensive medical history. “With one partner or more than one? Male or female?” I can do all that "doctor stuff" without batting an eyelash, but somehow when it comes to the mother-stuff of making sure my daughter’s emotionally okay, or figuring out if I’m asking too much or too little, saying too much or too little, I feel much less certain that I’m doing an adequate job. There’s no Netter Atlas of Parenting, after all.

I guess I just have to take my cues from her.

Photo: reusable menstrual pad with Kokopelli motif from Wikipedia article on the history of sanitary napkins
Link of interest, for the historically inclined: Museum of Menstruation

Tuesday, September 2, 2008

Guest Post: Vigilance 101

Several decades ago I began medical school as one of five women in my class. Medical school was followed by internship/residency at a tough city hospital in the days before 80 hour work week restrictions. So I considered myself a non-pampered full-fledged member of the medical profession. But after fellowship finished I was elated with the offer of a half-time job at a university clinic. The hours would prove perfect for raising young children. Of course, half time in medicine means 50% pay for at least 75% time. I worked 5 days per week, 6 hours each day, straight through lunch, so I could finish the workload and get home at a reasonable time. Outside of the regular clinic hours I was also responsible for any of my patients that were hospitalized and for every other week 24/7 on-call. But it was all tolerable because of the flexibility. I essentially job-shared with a near retirement age physician who had raised a large family and he was welcoming of my bringing children to work on the occasional school holiday or child care emergency day.

My rude awakening was the chance spotting of a young male physician at the shopping mall one mid-week afternoon.

“Hi – are you on vacation this week?”

“No – Wednesdays are my discretionary time”

“Discretionary time???????”

“Yes – the day I don’t see patients. It’s the time I write my book, review residency training curriculum, do phone conferences…”

OK, I calculate. He’s my age, same amount of training, hired by the same university division. I work 5 days x 6 hours = 30 hours in clinic for 50% pay. He works 4 days x 8 hours = 32 hours in clinic for 100% pay. I did register a complaint which did nothing but label me troublemaker, but I was attached enough to my work hours that I didn’t pursue legal action. (That’s another story for when children were older).

Fast forward to August 3, 2008, The Outlook Section of The Washington Post. There’s an op-ed article by a physician bemoaning the current state of patient care in primary care medicine. No argument, primary care medicine is dying for a variety of economic reasons. But wait – our author has an answer. He claims there’s a “silver lining” in that many more women are entering medicine. Women tend to migrate to primary care fields, and they are documented to spend more time with patients even if they don’t get paid more. So there we go – cheap, undervalued labor is still with us!

Dr. Nana is a private practice internist in a suburb of a large east coast city. She has a physician son, a medical student son, and a physician daughter-in-law. Besides her clinical work, she is active in political action/legislative lobbying/educational efforts to preserve the practice of medicine, which is currently under assault on multiple fronts.

Monday, September 1, 2008

Mothering a med student

Pathmom has been off the air for many weeks, primarily due to the addition of a full time med student last month. I have a healthy amount of respect for med students (we were all students once), and this one was particularly bright and appeared to have the requisite "good eye" that any successful pathologist must have. So in the title of this blog, I don't want to sound pandering or condescending in any way, but there was an incident that I found particularly memorable, and worthy of sharing.

This young woman had a 4 month old baby girl at home. She came back from maternity leave and went straight into her general surgery rotations. Her medical school was in the habit of "farming out" students to community groups across the metro area (and even the country) for their clinical rotations. The two surgeons she rotated with were geographically close, but had a reputation for inappropriate behavior.

"K", as I will refer to her, had an initial interest in surgery, but she was fully cured of that in the process of her rotation. Apart from being bad-tempered and complaining vocally about having to have med students at all, these surgeons were apparently openly misogynistic. They reduced one female med student to tears by verbal abuse, got cited for making "inappropriate remarks" to another, and told "K" directly that the only way they would ever hire a woman was if she had a hysterectomy.

The last incident really burned me, but I was more appalled by the way "K" told me about it, almost like she was waiting for me to chuckle or at least smile.

"Are you serious? They said that to you?"

"Well, these guys are pretty old school."

"Old school, nothing! That's an extremely offensive remark!"

I had that bewildered sense of reacting very strongly to something that appeared to have no effect on someone that I would consider more or less a peer, based on age and being the mother of a small child. I explained that you can't change individuals, but that she should not take that comment as something either acceptable or amusing. I also thoroughly derided her medical school for allowing students to be with these physicians (apparently, options are rather on the slim side). Despite having quite strong opinions about many and varied things, I actually do not "soap box" very often. This, however, did ignite a spark. The term "flipped out" sums it up nicely.

I couldn't help but wonder if it was her upbringing or just a lack of social aptitude that made her fail to realize the abhorrent nature of that comment (and, yes, I am intentionally leaving out the option that I was just plain over-reacting).

I also couldn't help waxing philosophical about the whole incident. Obviously, this blog is built around the notion that mothers in medicine are worthy and capable members of the medical field. We are also, frankly, necessary to the system. If every "mother in medicine" were to disappear from the profession, and if only those women who were indeed sans uterus were allowed to practice, what then? Not so great for aging baby boomers, that's for darn sure.

This student was convinced that surgery was not an option for her - and maybe it wasn't her path for other reasons - but these horrid surgeons certainly made it clear that she wasn't a candidate based on who she was. "Of course you can be a surgeon!" I explained to her that my sister-in-law is a practicing general surgeon, and has had two girls and plans to have more. I also pointed out that 3 of the 6 general surgeons at my hospital were women, all of whom had small kids. That being the case, I had already melded her mind towards the utterly cool and completely irresistible field of pathology, so I believe it's unlikely she will do anything else (path props).

Frankly, mothers in medicine typifies a scenario that all professional women of this era face: creating the reality of how working moms fit into the American workforce in the 21st century. We're living at a time when there is no "norm" for working mothers, and the expectations and experiences are supremely varied. Some moms get months of maternity leave with full pay; others get paltry weeks (or even days) and pro-rated salaries. Some moms have to take leaves of absence; others invoke FMLA. But we are an increasingly powerful and valuable voice in the professional community, and I believe the situation for working moms reflects that more with every passing year (a generation ago, my mother in law and her female residency colleagues had to sign contracts with their programs explicitly stating they would not get pregnant - they did anyway). We are more involved in making our own reality today than ever before, and I believe that what we want to be and how we want to practice are out there waiting for us, be we single, married, pregnant, or toting around that mysterious black bag with the plastic suction devices on it. And if there are still the remnant neanderthals who feel that the possession of fully function female parts excludes someone from consideration, they are, of course, free to limit themselves thusly while the rest of the world spins ahead with diverse, talented, and dedicated mothers in tow.