Wednesday, October 8, 2008
It is killing me. Nightly.
What kills me more is what happens when I dutifully trudge back downstairs to the kitchen to fix him a bottle of expressed milk and give him the bottle.
He grabs the bottle with both hands, shoves it in his mouth, and proceeds to twist and fondle the bottle like he has just been reunited with his best friend. He slaps it with one hand. Giddily moves it from side to side. He drains it, then.
I should be happy, right? He is providing a prime opportunity for me to finally wean him, just as I planned months ago. Six months was my goal. Nine months was my reach. I'm under doctor's orders to stop at 9 months (osteopenia, long story). He is a champ at eating solids and is very close to walking. But, even though the time appears to have come, I still don't feel ready.
Last night, I searched "nursing strikes" to reassure myself that this new rejection was due to him actively teething (hello bite bruises up and down my arms) and yes, the articles reassured me that nursing strikes happen for all kinds of reasons. (My bruises suggest teething, or perhaps my involuntary screaming when he bit me last week was poorly received.) They also emphasized the transient nature of these strikes and to push through.
In my internet searching, I also came across many sites that basically pounded The Guilt into me for even contemplating weaning before 12 months. About how no child would self-wean before 12 months, possibly not before 18 months. They talked about earlier weaning would only be for Mom's benefit (read: you are a selfish hog) and could result in less secure children. They said that mothers often misinterpret a nursing strike or normal developmental changes in the child to mean that they are becoming disinterested in nursing (read: you are ignorant and should not be allowed to procreate).
Poison in my eyes!
I thought of my 3-year old who I started weaning at 9 months during a very similar nursing strike. I remember feeling similarly sad and rejected, solemnly repeating the words, "It's the end of an era," to my husband and anyone else who would listen. Was I wrong then too?
Here, I was, thinking that I was almost deserving of a medal for working full-time, pumping 3 times a day to keep up, and downing Mother's Milk Tea every single day (I'm not a tea person, and definitely not a nasty tea person) to feed my son exclusively with breastmilk for 9 months. And then I read this article which makes extended nursing sound so beautiful and bonding that I'm left feeling inadequate.
I think it might be time. But, no one makes this easy.
Tuesday, October 7, 2008
My father-in-law once told me (regarding parenting) to remember that we know better than them. (he said this as I was struggling to force antibiotics down)...but I often recall this phrase. I know that my 2yr old will enjoy and benefit from the socialization and learning she will get at school. And most days I'm sure that even if I was home I would want her to go to school for her sake...but then I'm not entirely sure I'm being objective.
I guess for now, I'll enjoy the moment, her excitement to go to school and hope that when I pick her up tomorrow she has a smile on her face because it will surely make it harder if she's not happy.
Monday, October 6, 2008
And they're all kind of stupid burns. Like when I explain what happened, I'm actually embarrassed. Not that there's any smart way to burn yourself. But some stories are dumber than others, like when I burned myself while trying to move a boiling pot with my bare hand. SMRT.
(My father actually has the stupidest burn story I've ever heard from a real person: he burned his chest while trying to iron the shirt that he was wearing. He's a doctor too.)
I've theorized that the reason I keep burning myself is that I'm cooking under very pressured conditions. Admittedly, I don't have some British guy yelling curses at me, but I've got a two year old who alternates between standing at the gate to the kitchen and screaming or toddling over to my bookcase and throwing books all over the floor. So I'm feeling a bit rushed to finish up dinner before our house is ripped to shreds.
Plus I'm just a wee bit tired from working all day so I'm not at peak performance.
Just because I'm a doctor, my husband thinks I know the best way to treat a burn. I don't. Last time, I tried everything that The Great Internet had to offer before the pain eventually faded away on its own. I seriously had toothpaste smeared on my hand at one point.
I get very frustrated by these burns because they keep me from doing what I need to do. I can't take care of the baby (change her diaper, give her a bath), I can't concentrate on studying, I can't wash the dishes or clean up. I can't be Supermomdoc anymore. I usually end up in tears over these burns, even the really tiny ones. It makes me realize how little breathing room I have in my life. Sometimes I worry I'm just two or three burns away from the edge.
Thursday, October 2, 2008
So, picture the scene. It’s Wednesday, my late day in clinic. I get home at 7:15pm. Bedtime is officially at 7:30pm. The kitchen looks like a still shot from Storm Stories. No one is in the tub yet. A quick survey of the kids’ bedrooms alone foretells at least an hour of “pre-cleaning” for our once-a-week housekeeper visit. I breastfeed “Fig,” our 7 month old, on my lap while attempting to eat a petrified bagel that I actually toasted YESTERDAY morning and never managed to get out of the toaster because at least, it’s ready to eat, lunging simultaneously for 4 year old “Munch” who is begging to be tickled over and over in the next seat, all while nodding and listening to precocious not-yet-3 “Iggy” describing random events of her day in what has to be the world’s longest run-on sentence ever, except this one. Everyone eventually gets washed, combed, toothbrushed, pajamed, read to, and tucked in. The house is returned to some semblance of order. Finally, after 2 ½ hours of the parental version of running uphill on a treadmill backwards, it’s 9:45pm and we collapse in bed to say hello to each other for the first time. Then my hubby drops the bomb. “The Comfort is leaving on Sunday.” The Comfort is the Navy’s hospital ship. I am too tired to wonder why this would be the first thing out of his mouth when we haven’t seen each other all day. “Oh really?” I say. “This Sunday,” he adds hesitantly. “Wow, where are they going?” “Georgia…ex-Soviet Georgia.” “That’s really short notice,” I note with vague disinterest. At this point, he obviously can’t take my dementia of exhaustion another minute and says, “I’m on it.” “WHAT?!?!?!”
And, in that moment, the juggler lost her left hand in mid-act. Suddenly I had 72 hours to figure out how to swing being both the “drop-off” and the “pick-up” parent, who was going to get my son to his weekly PT appointments which were right in the middle of my late afternoon clinic, how I could even register our kids for the preschool they have been so excited to restart which required being in line outside the school by 5:30 am the day after he was leaving, what I would do if we had a childcare crisis since I had just used up every iota of my vacation and sick leave and then some from taking 4 months of maternity leave, and on and on. My mind raced. The list grew. The punctuation vanished.
Ok, I told myself, you can do this. You have done this before. He had been deployed for 19 weeks while I was pregnant with our third child, just gotten back only 10 months prior in fact. We already knew he would be deployed again in April 2009. But for those, we had time to prepare ourselves and the kids, time to make arrangements, time to exhale and come to terms with it. This time, it came out of nowhere. Well, it wasn’t entirely out of nowhere. There was a moment, I think, during my commute two days prior when I heard on NPR that Russia had just bombed Georgia, a fleeting moment when I thought to myself: “Uh-oh”. But I put it out of my head, reasoning that we couldn’t be in Iraq AND Afghanistan AND Georgia. Our military was stretched too thin as it was. And there was an election in a matter of months. No, nothing to worry about.
The next week after that Wednesday night bombshell went by in a blur as I attempted to cancel and reschedule our lives, make contingency plans, prepare the kids emotionally when I wasn’t even prepared myself. The miraculous news that the entire US deployment to Georgia would be canceled came several days later, not from the US Navy, but rather from a Baltimore Sun reporter and new personal hero named David Wood. That is a saga in and of itself for those who are interested: http://weblogs.baltimoresun.com/news/militarywatch/2008/08/post_45.html. But this is one long preamble for the real topic of this blog.
The next woman I saw in clinic was a new patient, 34 years old, a mother of 4 kids ranging in age from 1-7, widely metastatic breast cancer, a recent move from out of state for her husband’s high-travel job, no immediate family on either side, and no friends to speak of yet for 800 miles in any direction. She reported in a perfectly matter-of-fact way when I asked about her meds that she takes an extra dose or two of Oxycodone to control her bony pain enough to be able to make the kids dinner and do their baths. I was paralyzed by awe, by shame, and by the perfect storm of awe and shame: humility. As I sat wringing my hands over my husband’s unexpected, uncertain, and slightly risky deployment of probably a few months—maybe six at most—here sat this woman in constant pain, facing her own certain mortality, juggling despite having lost both arms, knowing that if she even blinked or faltered ever so briefly, it was over. Permanently. And her husband. What would he do? When she was gone, he would be on his own until the last baby was grown. And he worked full-time. Traveled several days a week. Seventeen years. It was an eternity. It was incomprehensible to me. How would he ever manage? How did he even lift his head off the pillow every morning? Here sat this young couple in front of me, and I was supposed to be the wise one? The doctor? And, in that moment, I became a medical student again. Suddenly I was the same young woman who years ago stared wide-eyed as patients gave their spouses a last kiss before being wheeled in for their liver transplants, wondering if they would make it, wondering how they managed to smile, wondering how they could be so strong, wondering whether I could ever be so strong, hearing that disquieting voice that told me I knew the answer and it was no.
It’s been over 6 weeks since this all happened, but I am think I am permanently that medical student again, if a bit more wrinkled these days. I realize now that every patient I see is living some variation of this story. She is trying to get her chemo and get home after dropping off her son at preschool and before her daughter gets off the bus and hoping her nausea medicines will work well enough that evening for her to cook dinner without the smells making her sick. She is terminally ill and desperately wants more time at home but cannot quit her full-time job because, without it, she will lose her health benefits and therefore, the treatment that may give her another month or two with her children. These people are all juggling more than I could ever comprehend and with so much more at stake.
I finally got it. After so many years focusing on whether the grass was greener on the other side, I finally realized that my grass has always been green. I just never sat still before long enough to notice.
Wednesday, October 1, 2008
Have you heard of DonorsChoose.org? It was started by a former teacher as an experiment and now is an alternative funding source for teachers nationwide. Teachers upload projects they want sponsored such as Biology Lab basic equipment for a Mississippi high school where students have never had an exposure to a real laboratory ($818). Donors can contribute as little as $5. DonorsChoose purchases the supplies and ships it to the classrooms, along with a disposible camera. Donors receive thank you notes from the children, as well as photos.
According to Fortune magazine, "Donorschoose.org has raised $24 million to get support to 1.4 million students in 50 states. Nearly 60,000 projects have been funded."
Now, to the competition.
Starting October 1st, bloggers around the country will be competing to see who can generate the most donations to DonorsChoose classroom projects. Last year, blog readers donated $420,000 toward books, art supplies, technology, and other resources, reaching 75,000 students in low-income communities.
Mothers in Medicine in joining in and we're hoping that we can show the internet who wears the pants. Please visit our giving page and see what projects we've selected to raise funds for. You can also get to our giving page via that nifty widget in our sidebar. After donating, you can leave a message for the students you are helping. Since the giving account is under Mothers in Medicine, leave your name, if you wish, in your message and where you are from.
Give if you can!
Tuesday, September 30, 2008
In residency, I fell off of the proverbial friendship map. In the pre-80 hour a week era, I could work up to 120 hours a week (every other night 24 hours on call). It was in residency that I developed an odd social phobia involving the phone that I have to this very day. I just stopped answering it unless it was my mother or my husband. I stopped making simple calls like for pizza or take out entirely. I think that it stemmed from the fact that I *had* to answer the pager. I didn't have to answer the phone or call anyone if I so chose. It wasn't that I didn't *want* to talk to other people. It was that I *couldn't* talk to them. I just couldn't give any more of myself away. As a result, I slowly lost touch with friends that I loved very much, but to which I couldn't be a very good friend at the time. Next came parenthood, a new job with little time off, and another baby. There was not much time for extra socializing, though I realized that I needed adult friendships badly.
As I take the steps toward a new job, closer to friends and to family, I have also begun to reach out to old friends in an attempt to reconnect and apologize for being such a crappy friend to them. A rather recent discovery that has been great for this is facebook. I have gotten back in touch with old sorority sisters and my college roommates through this networking tool, and for that I am grateful. I've arranged a few tentative visits with important friends in my life that I haven't seen in 3 years or more. I feel like I am on my way to rebuilding these relationships, due in part to a few easy clicks of a mouse. So facebook worked for me, how do you stay in touch with your close friends that don't live near you?
Monday, September 29, 2008
I read with interest this CNN article about Pakistan's president complimenting Sarah Palin on her looks:
"You are so nice," Palin said, smiling. "Thank you."
And then, when Zardari quipped that he would like to hug her, "Palin smiled politely."
I was reminded of the similarly awkward exchanges that occur between female physicians and patients or colleagues. Palin employs two responses that are favourites of mine. First, receiving the compliment as an innocent remark. Then, reacting with a cool silence to an inappropriate, but not quite lewd, suggestion. It would have been interesting to see what she would have done had it escalated.
I'm curious what others think of Palin's response. Should she have been less amiable? Used a different tactic? How do you deal with positive references to your physical appearance in the workplace?
I find this tricky. Sexual comments and overt invitations are obviously inappropriate and need to be dealt with immediately and decisively.
But what do you do if a patient tells you you're beautiful? What if it's said in a frank, admiring way, with no innuendo? A woman can be told she looks great because she's healthy, rested, happy, young, well-dressed, has a good haircut or a host of other reasons. I don't think all compliments can be assumed to be romantic or sexual; they're often made as a kind gesture.
The range of scenarios further complicates things. Does it make a difference if the comment comes from a geriatric patient, or a thirty-year-old? From a one-time consult, or a long-term patient? What if the remark is made by a colleague?
What if it's a neutral observation? Is the boss who comments on the length of your hair at every quarterly meeting, or the patient who notices your new shoes out of line?
To some degree, I consider any comment on looks inappropriate, because a physician's appearance is unrelated to the provision of medical care. Such remarks are irrelevant and unprofessional.
But don't we respond differently when women pay us compliments? If a female patient comments on my new haircut, I'm pleased. If a nurse is wearing fantastic boots, I'll tell her. We don't behave as if compliments should be banned from the office altogether.
I think the most difficult situation is the one where the exchange is with a superior. When I was a medical student, a physician moderating a small group session put his arm around my shoulders, squeezed me and exclaimed, "You are so cute!" I recall that I was wearing a plaid jumper and tights. Maybe I inspired a school-girl fantasy, but more likely I just reminded him of his own teen daughters. I was acutely uncomfortable, but I didn't know what to do. So I did nothing.
Now, my approach is to trust my gut. I'll gracefully accept a one-time compliment. I'll laugh off the jokes by the sweet old man with his wife shaking her head beside him. I swiftly derail anything that becomes persistent, or comes from a patient with psychiatric issues, or causes me any unease.
None of this is to say that I am as gorgeous as Sarah Palin.
Gordon: "Elmo, what's wrong?"
Elmo: "My feet hurt!"
Gordon uncrosses Elmo's legs as he again cries out in pain.
Me: [thinking] "Oh my god, is it an ATFL sprain? Is it plantar fasciitis?"
Gordon: "Elmo, I think I see what the problem is."
Me: [thinking] "Tibialis posterior tendonitis? Achilles rupture? Talar dome fracture??"
Gordon: "You put your shoes on the wrong feet!"
Wasn't even in my differential.
Sunday, September 28, 2008
When did this start? Why do I have a problem with sleeping all night long?
My first recollection of this sensation dates back to when I was an intern almost 20 years ago. A resident I worked with was fond of heading to the on-call room as soon as possible during call nights and jumping into an open bed. His rationale was that any sleep was better than no sleep and 45 minutes of sleep at 7PM might well be the only sleep of the night. I still recall the first night of call when I decided to do the same; I headed to the on-call room and tucked into a lower bunk, optimistically setting the alarm in the room for the next morning. I woke the next morning to the sound of the alarm blaring and immediately wondered why I hadn’t gotten called. I frantically paged myself. When my pager went off, I hung up and did it again. Again, my beeper responded immediately. I found a toothbrush and freshened up as best I could, then headed down to the morning lecture. On the way, I ran across the resident who had been on call with me the night before. He grinned at me guiltily and then said, “You’ll never have another night like this. Savor it. But don’t ever talk about it.” His unspoken comments implied that sleeping during a night of call was frowned upon – even if there were no patients who needed the night intern or resident.
I recall the same sensation the first night both kids slept through the night. My initial drowsiness upon wakening abruptly vanished with the realization that I hadn’t heard the baby cry. Stumbling into the nursery expecting the worst, my fears resolved upon the sight of Eldest earnestly holding a conversation with his stuffed bear; a few years later, it was Youngest’s voice singing aloud which soothed my concern after a similar night.
But I still don’t know why I feel guilty after getting a good night’s sleep. Is it because I spend so much of my time fighting fatigue that I don’t know what to do when the feeling is gone? Have I grown so accustomed to chronic sleepiness from interrupted nights that what should be normal for my brain and body is now considered the aberrant?
Even now, after having been awake for several hours, I feel “off”. Is it extra energy, lack of fatigue, hypercapnia from sleeping with my head under the pillow for an additional ninety minutes?
So MWAS, here's a really long answer to your question of the other day: 7 hours to function, 8+ to feel good (but then I feel bad). Does anyone else have this guilt after sleeping well?
Saturday, September 27, 2008
Son is asleep on the couch next to me...couldn't make it through the presidential candidate debate. I know I should move him to bed, but I love the warmth of his feet pressed against my leg.
Last night, he woke up with growing pains. My mom is staying over to help me while Husband is
I gave him some ibuprofen, then put him in my bed and tried my best to comfort him. I rubbed his legs and sang songs. Twenty minutes later, he was asleep.
I had growing pains, and I know that's what Son was experiencing, but the doctor in me went wild thinking of more unlikely, and scary, causes of leg pain. Osteosarcoma. Rheumatoid arthritis. Leukemia.
I realized, after an hour of stewing, that I would have those fears even if I weren't a physician. It's a maternal impulse to fear the worst. I'm just a regular mom.
Friday, September 26, 2008
I talked to her of our good fortune: we are women in a society in which we are free to choose to be wives or not, mothers or not, with opportunities to educate ourselves, vote for our leaders, work at professions of our own choosing.
Thursday, September 25, 2008
Wednesday, September 24, 2008
Lately, I've been thinking a lot about how one area in my life is absolutely out of control, and how it affects both my patients and my children. That issue is lifestyle, and more specifically, my weight. When I started medical school, I took care of myself. I ate well, exercised, and got plenty of sleep. Not coincidentally, I was also a healthy weight. In the 11 intervening years between the start of medical school and now, this has all fallen by the wayside. I eat a terrible diet, often rewarding myself with food, rarely exercise, and sleep is inconsistently 6 hours a night, at best. I look at myself now, 14 months after my second child was born, and I know that I no longer have any excuses. I am obese with a BMI of 36. I didn't "just have a baby." It was over a year ago!
Day in and day out, I give weight loss, diet, and exercise advice to patients. Prior to medical school I was also a weight loss counselor. I *know* what to do. How can I expect them to listen to my advice, as a role model, when it is obvious I do not practice what I preach? Worse yet, how do I model a healthy lifestyle for my 4 year old daughter? I can't keep fixing her fruits, veggies, and healthy dinners while I eat a pound of pasta night after night. I can't encourage her to keep active and fit when I come home at night, exhausted, and plant myself on the couch. Soon enough, the questions will start.
In my quest for a better work lifestyle, I am also embarking on a personal lifestyle change. Mr. Whoo and I are taking the kids for walks before or after dinner. This week I have started a weight loss regimen that requires me to track what I put in my mouth. I've started over and over again in the last 3-4 years down this road. I need this time to be the last. I'm doing it for myself, for my family, and also for my patients. It is time to realize that *my* health is important, too. I want to be able to tell my overweight/overworked/overstressed patients "I did this, this is how I did it, and you can do it, too!"
How are you being a positive role model in your patients' and families' lives?
Monday, September 22, 2008
During my first year of residency, I was going to be 39 weeks pregnant when this three-hour exam was scheduled. Considering the importance attributed to this exam, I asked the female program director if I could either be exempt from the exam or take it under circumstances more comfortable for a woman who was nine months pregnant, since three hours straight in a tiny desk with a hard wooden chair did not sound tempting.
Before I conclude this little anecdote, I want to say that I bet I know what some of you are thinking. You're thinking, "What's the big deal? I took my REAL board exam while nine months pregnant, also while breastfeeding a one year old, and pumping during my 15 minute breaks. Also, I had eclampsia at the time and was actively seizing. And I didn't complain."
Admit it, that's what some of you are thinking.
Which isn't so far off from the response I got from my program director, who was the mother of three small children. She told me (via email), "We'll see. I was still answering pages when I was in active labor."
I'm not as strong as all that. When the epidural went in, my pager went OFF.
Still, this incident made me aware of the fact that while other physician mothers ought to be our greatest advocates, sometimes they are our worst enemies. There's a general thought from some female physicians: "If I did it, then why can't you??" I think we've all had encounters with physicians mamas who showed a surprising lack of understanding, sometimes even worse than the men.
I'm guilty of it too. When other women with kids take off a day because their child is sick, I automatically think, "Well, I came to work when my daughter was vomiting." Or when another resident started her maternity leave a whopping month prior to her due date, I couldn't understand why she was unable to work till the very last day, like I did.
And I hate myself for thinking that way. Female physicians should support each other and work together to foster understanding and acceptance of things like maternity leave or having non-insane hours that allow us to spend time with our kids. Everyone is different and just because we were able to work until the last day of our pregnancy or pop back to work three weeks after delivery or have a nanny that never calls in sick, that doesn't mean we shouldn't stand up for other women who might not be exactly like us.
(In case you were wondering, I was granted extra time for that exam.)
Wednesday, September 17, 2008
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