Wednesday, November 12, 2008
Dear Fat Medical Student,
You worry too much. It's gotten you this far, but enough is enough.
Years from now, it won't matter if you get a 92% instead of a 100% on an exam. You won't care if a resident thinks you are lazy for wanting to leave just two hours late. You won't even remember your step one score, but you'll remember the hangover from the celebration upon passing the test. Years from now, your patients will love you because you care. They won't care if you don't know all of the answers as long as you know how to find them.
You'll be a family doctor, a combination of all of your "favorites"...internal medicine, pediatrics, obstetrics/gynecology and psychiatry. You'll know a little about a lot of problems but not a whole lot about any of them. You will be comfortable referring to specialists. People will tell you their deepest secrets and will care about your opinion. Don't let them down.
Years from now, a lot of your "hero" teachers will seem emotionally immature to you once they are your colleagues. You'll watch them be cruel to ancillary staff, students, their families and, heartbreakingly, some patients. You'll feel superior to them in all ways other than raw knowledge. Don't put them on a pedestal until you are sure they deserve it.
Don't be so desperate to find a mate now. You will marry your best friend and have happy children. You'll see.
Years from now, you'll be sorry you quit walking the dogs when you got a fenced yard. You'll regret those drug-rep bagels, too. Stop when you are 15 pounds overweight and you'll never be 140 pounds overweight.
You will hurt many patients...not with malice but with honest mistakes, misjudgments and quirky fate. Decide now how you will handle it so it doesn't kill you. You'll cry about these circumstances because you are a good person, but don't let the bad outcomes make you jumpy.
Years from now, you won't care about money because you'll have some. Save for retirement and live below your means. Your loan payments will be a small part of your overall salary because you borrowed wisely.
Years from now, you'll find yourself wanting to snap at people in "ordinary" life. Practice now how to manage fatigue so you don't become an ass. Medical students will turn to you for a kind word or emotional support and you should give it. Always.
You'll be glad you spent time with your nieces and nephews even when finding time was difficult because the children make your life whole. Invest love in them and it shall be returned when you are back in diapers.
Years from now, you'll be a generally happy person. Of course, you'll wonder what might have been in you hadn't chosen medicine. You'll consider chucking it all and going to cosmetology school. Don't let your mind go there. On the day when you decide you are in the wrong career, a patient will tell you that they credit you for helping change his or her life. It will feel good.
Enjoy the success...it's what you wanted.
Future Fat Doctor
Well here you are…. All grown up and getting ready to start Medical School. The things you are going to experience are going to blow your mind. No matter how hard things get I want to let you know its all worth it. In the future you are happy and love your profession. But, there are just a few tidbits you should know:
Those student loans are really hard to pay back. Don’t take out any more than you need. Also read the book “The Millionaire Next Door” as well as “The Richest Man in Babylon” the summer before you start med school.
Don’t become a D.O. Right now you are sure that you are going to practice rural family medicine, this will change when you start rotating through different specialties. You are being told that being a D.O. will not affect your ability to get into residency. This is not true. You will seek to match in a competitive specialty, and it will be harder for you to get a spot. It will also make it harder to get a fellowship. (This is not meant to spark controversy. I feel my Osteopathic training was outstanding and I love the profession. It was however detrimental to applying for residency positions and I was mislead on this issue when I entered school)
It will all work out. Don’t freak out when you realize that you want to be an OB/GYN. Do what you love. YES, you will be able to have a family and a somewhat balanced life.
SUPPORT you fellow female students/residents when they say they are being sexually harassed. Never just think they don’t have a sense of humor. Never look the other way when people say sexist or racist comments, even if they are your superior, stand up for what is right.
When you are an intern you will be convinced that your Chiefs are evil (well one of them is, but she will get fired). They are not. They really are trying to help you and they are just trying to survive as well.
Don’t eat so poorly as a resident. If you eat a second “dinner” at 3 am, you will, in fact, gain 20 lbs in 6 months.
Nothing I can tell you now will prepare you for having a baby. Just a hint, there is nothing better in the world than seeing your child for the first time. Your heart will grow in the most dramatic way. The nausea, constipation, Mag….. all worth it.
Shave your legs with your left hand. This will help improve your dexterity and surgery skills.
Don't wish away your life (except intern year. It will be awful and life will be significantly better when its done). Enjoy each stage as much as you can.
You husband, family and friends are amazing. Don’t ever take them for granted.
Enjoy the ride!!!
-When starting, I wish someone would have told me that the daily grind of medical school would be the hardest thing that I’d ever done to that point.
-The smell of the anatomy lab will eventually fade. With luck, everything you learned there won’t.
-It’s OK to not know what you want to do with your life; spend your time during rotations and clerkships learning as much as you can. Likewise, it’s OK to be completely grossed out by sputum samples.
-Learn to listen to your gut regarding patients and yourself. It’s part of the art of our profession.
-Every once in a while stop to thank your support systems: parents, siblings, friends, significant others, spouses. Med school is a tough row to hoe (so to speak), and they’ve got your back while you’re cramming for yet another exam. Don’t get crazy - you haven’t got that kind of time.
-You’ll never know it all, so don’t panic when you realize you don’t. This profession is built upon learning regularly, so learn to learn quickly and efficiently. And teach what you’ve learned – it’s the best way to reinforce your knowledge and pay back those who you feel were good teachers.
-Above all, remember that you're never alone. Don't be afraid to ask for help.
As I reflected on what might be helpful, I came to the conclusion that some of the best support I received along the way was hearing other women's stories. For me, it helps to have anecdotes of success to reassure me along the way. Nothing has been more uplifting than knowing that I am not alone in this journey of motherhood and medicine. It has been other women's random stories, hodgepodged together, that have given me strength, motivated me, and given me ideas on how to improve: do it differently, do it better.
The other day I was at my pediatrician's office with one of the boys. I encountered another pediatrician who was substituting that day in the clinic. "Dr. K, I'd like to introduce you to MSM, she is a med student with three boys and another baby on the way." Dr. K looked up from her chart and flashed me a huge smile. She pulled me aside and immediately introduced herself and gave me her story.
"Oh, I started medical school 8 weeks postpartum with our third child. In the summer after second year, I gave birth to our fourth. I wanted to take a year off to be at home with my kids. I suggested to the dean that if men were allowed to take a year off between second and third years to 'find themselves' that I was already 'found' and needed to cultivate it. I took the year off and returned to school; subsequently, I matched into a peds residency on a part-time basis for the first year and then finished full time."*
She then continued on as I stood there with my mouth open. Rarely do I encounter women with stories quite so similar to mine.
"If you ever feel like quitting, if you just have one of those weeks and everything feels overwhelming and not worth it, if you feel like your babies don't know who you are and you're stressed, call me. I can guarantee that I have been there. Many times, in fact. But I can tell you, for me, it has been worth it. And I would be more than happy to help if it ever comes to that for you, too."
She then handed me her number and went on to see the next patient. I have to say this made up for all the times that people have looked aghast when I tell them that, “Yes, we are having a baby. And no, it's not our first or even our second, but our fourth.” I feel like a rare irresponsible bird, which I loathe. I suspect they think I must have slept through the reproductive medicine lecture on IUDs, and what a wonderful contraceptive device they are. But ultimately, I've learned not to say anything. I often hear from fellow classmates, "I don't know how you do it. I can't even take care of myself." Despite the desire to retort, "I don't know how you go out drinking as often as you do and still make it to class, functioning no less." I decide not to. Since it's rhetorical anyway. Right?
But here's my long winded point: so far I've experienced a pregnancy in every year of medical school. I had an infant when I started first year. Halfway through that school year, we started trying for number two and ended up with a bonus (I got pregnant with twins). At that point, I took a year off to do research and to care for the babies. The following year, I returned full time and got pregnant at the end of second year. I passed step 1 and started my third year with my surgery rotation. There have been good and bad points along the way. But for me, it has been an extremely rewarding, incredibly busy, but amazing period of my life.
The chaos that accompanies four small children (or even the kids themselves) is not for everyone. I’m definitely not recommending this path to everyone- but to the women out there contemplating entering medicine but hesitating because they feel overwhelmed by the impossibility of family, school and medicine, I can finally return some of that reassurance I have received over the years. Follow your dreams: their individual paths diverge less than you fear, and you can always problem-solve ways to bridge the divide.
*I didn’t have the chance to ask Dr. K’s permission to share her story so I changed any identifiable details, though, I don’t think she would mind inspiring or reassuring anyone out there.
MSM is in her third year of medical school and has just had her fourth child. She enjoys running, cooking and being with children. It will come as no surprise that she's planning on going into pediatrics.
Monday, November 10, 2008
Sunday, November 9, 2008
Anyway, Miss Beauty Queen was interested in going to med school.
Over the course of the rotation, I did my damnedest to talk her out of it. Every single day, I told her a different true story, some titled "Med School Sucks", others titled "Being A Doctor Sucks", most under the general heading of "I'm Really Tired". Some of those stories were lifted right off this blog. Also, she would be a little older than the traditional students and I reminded her that OMG, your biological clock is ticking! Babiezzz!!!
She was very surprised by some of the things I told her. She said that most people were really encouraging when she told them she was thinking of going to med school, especially when she told them she had doubts about it. (I was surprised by that, because I thought all doctors were bitter.)
Whenever I meet a pre-med, as a rule, I always try to talk them out of going to med school. It's not so much that I think nobody should go to med school. Clearly, there are people who are born doctors and love it. And if nobody went to med school, I'm pretty sure everyone would end up getting diagnosed and treated by Dr. Wikipedia.
So I'm not against med school. But I figure if there's something that I can say that is enough to talk a person out of going to med school, they're probably better off changing career paths now than when they have negative $200,000 in their bank account. Because medical training is damn hard and most people just don't understand that, I mean really understand that, until they're in too deep. I feel like if I can keep even one person from making a mistake, it's worth it.
On the last day of the rotation, Miss Beauty Queen told me she was going to business school.
Friday, November 7, 2008
Okay, I'll just come right out and say it: I was T-boned by a bus on Tuesday and have a type III odontoid fracture. I am now in a neck brace for 6 months but lucky to be alive and not paralyzed. I cannot even begin to explain all the thoughts and emotions that one goes through - from the coldly rational (wow, this is what it's like on a backboard, in a collar, in MRI) to the wildly emotional (DAMN DAMN DAMN, there goes the concert I was going to give, there goes the clinical study that was going to make JAMA, there goes the dressage show I'm ready for, and there goes vacation with the kids in the Carribean). But the one thing that is the MOST heartbreaking: not being able to scoop my kids up into a big bear hug.
Trying to be the optimist I'm struggling with what to do with months of non-physicality. Go ahead I think, perfect that Spanish, read all the library books, type up my diaries, catch up on all the movies - but somehow it pales in comparison to the dreams I was already embarking upon and achieving. And although I'll be home (always), I'll see the kids less because I won't be taking them to piano and swim and school and birthday parties like I usually do. But it's early yet - perhaps as a result, the kids and I will have more bonding time with the hubbie and our nuclear and extended family as well as friends may become closer still.
The weirdest thing is (harkening back to psych) that my schema of myself is slow to change. I keep having to remind myself that IF I move my neck the wrong way, or trip and fall, it could be disastrous. But it still doesn't seem real until in moments of sobbing I realize it is. Now excuse me while I go cry.
At her first visit, I spent 45 minutes with her, evaluating and discussing her problem, showing her the MRI films, explaining what the options were. We discussed her anxiety and depression and talked about how that fed into her chronic pain. She did well with one injection, and seemed fine at that 20 minute followup visit. Now she returns after the second injection:
“Why didn’t you make me numb for this shot like you did the first time?” Tears. “It hurt so bad!” Tears. “Why did you let me be so anxious in the recovery room?” Angry stare. “I have some QUESTIONS.”
Now, I do the same protocol with every injection, including IV Versed for sedation. I know I did nothing different the second time, but no matter what I say, she gets more upset. Finally, after accusing me of telling her at her first visit that she needed surgery, and now telling her something different, she announces, “You and I are done, then.” I offer to refer her to another physician, and she snaps, “My own doctor can find me plenty of doctors who will care more!”
As a professional, I’ve been here before, and I know not every patient is going to get along with me. It’s her choice, and I’m fine with that. My brain tells me I shouldn’t let it bother me and that this patient has issues I’m not going to be able to solve anyway. *You can’t make everybody happy all the time.* I can’t even make the fixable problems better 100% of the time. The studies confirm that.
My heart tells me that I went into neurosurgery to fix people’s problems, and I should be able to help every patient I see. Because I do care so much about every patient and because I try so hard, every patient should understand that and be happy and grateful. If a patient doesn’t get better or doesn’t like me, that’s my fault. I’ve done something wrong or not done enough, been supportive enough.
No matter how much my brain tells my heart to shut up and be realistic, I can’t reason it away. This will bother me for days. It always does. The 29 patients I saw back today doing great, who’ve thanked me for my help, don’t make this better. I love the successes, but I wish the failures wouldn’t hurt so much.
gcs 15 is a 39 year old full-time neurosurgeon in private practice in a beautiful Southern state. She has a 10 year old son who plays travel soccer and ice hockey. Her wonderful, Type B husband is a primary care MD who quit medicine to be a college professor and loves teaching premed students. She adores her job but hates the politics involved in the practice of medicine. She's always struggling to find ways to get more hours in the day.
Thursday, November 6, 2008
As always, we welcome guest posts from readers. What would you tell entering women medical students concerned about future work-life balance? Career choice? Residency? Being an attending? Being a mother? What would you tell the younger you, if you could time travel, about life on the other side?
Please send any submissions to mothersinmedicine(at)gmail(dot)com and include a brief bio if you'd like.
Wednesday, November 5, 2008
A nice fellow came out, looked around, sprayed some stuff inside and out, then rang the doorbell again to give me the receipt. I thought the transaction was over, but it was just beginning. He also had a very long verbal list of suggestions of things to do to keep the ants from returning. It included removing all of the flowers from the beds adjacent to our home and sidewalk and replacing them with stone (or nothing), taking out all of our bushes whose roots might contact the home, removing the vines and other random vegetation touching our foundation, cleaning out the dishwasher filter twice a day and promptly cleaning crumbs, drips of juice, etc up when spilled, recaulking our kitchen counters and every other little gap in the kitchen, installing quarter-round moulding in several areas of the kitchen, emptying out our sandbox on the deck and powerwashing the desk, and "ideally" redoing our relatively new deck floor so that the gaps between the boards would not be so small as to provide a place for the ants to set up shop and build their nests. I'm sure I've forgotten some of them, but those were the biggies. When he started talking and told me that just spraying wouldn't be enough, we would also need to do a little work around our house, I thought, "Sure, of course, that's reasonable. He's going to tell me to try to mop the kitchen every day--I can do that, in fact, I'd like to anyway." Then the list started and went on and on and on. At some point in the list, I was amused, then kind of annoyed, and eventually came to a complete and final stop at hopeless. There was nothing to be done. We would have ants forever. So be it.
The next day in clinic, I heard myself giving a patient the list. It was a woman with cancer and a number of other medical problems, many of which were caused or exacerbated by lifestyle choices. I sensed that we had a strong connection, she was really listening for the first time ever, she seemed motivated and invested, and I had my in. This was my chance to really change her behavior. So I went for broke. I said she had to stop smoking, period. Her chemo wouldn't work as well if she continued smoking. Her breast reconstruction was more likely to be unsuccessful, from a vascular standpoint, if she continued smoking. If she survived the cancer she had, she'd be far more likely to develop another unrelated cancer if she continued smoking. She needed to eat less fat and lose some weight because we know that obesity is associated with a worse outcome, and a low-fat diet has been shown to reduce the risk of recurrence in a large randomized trial. And she should stop taking phytoestrogens--there were lots of them among her lengthy list of supplements. If she could manage to do an hour per day of exercise, that would be helpful too, and ideally, the program would include a half hour per day of the most vigorous exercise. Oh, and the other thing is...on and on and on. I saw her eyes glaze over the way mine did with the exterminator. I had her for a minute, then she looked vaguely amused, then she got a little irritated, and then she just got the zombie eyes and nodded in completely non-genuine assent. She had no intention of doing anything I asked. The requests were too numerous, too overwhelming, too unrealistic. The message--that she had the power to change her lifestyle and really impact her health in a positive way for the first time in her life--had been buried. In my enthusiasm, I had slammed shut the window of opportunity.
I saw another patient later that day who admits to smoking 3 packs a day, which probably means 4, and has for over 40 years. She also has a long list of medical issues related to lifestyle choices. At the end of the visit, I said, "I'd like to see you try to smoke less. Do you think there's any way you could cut your smoking back by one cigarette per day each week?" She said, "One less per day? That's it? Sure, I could probably cut out 2 or 3 without even missing 'em. You really think that matters, a couple cigarettes less per day, when I smoke 3 packs a day? Yeah, I can definitely do that. You watch, doc, I'll be down to 2 packs a day when I come back to see you in a couple months."
Sounds like a plan.
Tuesday, November 4, 2008
I start work at nine. I get up at six.
Even though we make lunches and lay out everyone's clothes the night before, we need that much time to get all five of us packaged and delivered to our respective places of work and play in good spirits.
I shower, dress and oversee the kids pulling on play clothes or school cardigans while Pete makes breakfast. There's a flurry of smoothing hair into pigtails, stowing rain boots in backpacks, pouring coffee and hunting for library books. We drive Saskia to before-care at her school. Then we head over the bridge and into the city, where we bring Ariana to daycare and Leif to preschool. Finally, Pete swings by my clinic and drops me off on his way downtown. I use the half hour before my first patient to review lab results and catch up on work email.
At two minutes to nine my colleague flies through the door, unstrapping his bike helmet. He's forty and single. His hair is a mess, he's out of breath and he seems exhilarated. "I woke up ten minutes ago," he announces. "I just rolled out of bed and out the door!"
Watching him hang up his reflective jacket and rummage in his briefcase for a granola bar, I vaguely recall a life where my only real responsibility between waking up and presenting at work or school was to put on clothes.
Now, I can hardly remember what it's like to show up at the office without feeling like I've already done a full day's work.
Monday, November 3, 2008
"I'm a PGY4 in PM&R."
"You're a what in what?"
Basically, we deal with sports and other musculoskeletal injuries, as well as the subacute medical management of patients with neurological injuries, including brain and spinal cord injury. It's supposedly a "lifestyle" specialty, which is illustrated by the joke that PM&R stands for Plenty of Money and Relaxation.
Of course, it's not all money and relaxation, especially during residency. But considering I had no in-house call, even during my first year after internship, I can't complain too much.
Lifestyle specialties are usually popular among all applying med students, not just women who want to have kids. That or skin is just SUPER interesting. It's definitely a lot easier to have children if you're in a specialty where the hours are manageable. I won't lie and say that lifestyle wasn't a significant part of my decision.
PM&R is somewhat like psychiatry in that it's a lifestyle specialty that isn't terribly competitive, probably because people don't want to do what we do or don't know about it. The more competitive lifestyle specialties are dermatology and radiology. Family medicine is another favorite among women who want to have kids (it's got "family" in the name, so it MUST be family-friendly). There are some internal medicine specialties that seem to attract more women, like rheumatology and endocrinology; cardiology, not so much.
Anesthesiology was extremely popular among women in my med school class. I never quite understood that, because the hours in residency seemed pretty rough, and it's one of those residencies that tends to get harder as you progress, with more responsibility. But apparently, the jobs after residency are great.
As everyone knows, the field that is probably most dominated by women is OB/GYN, which is decidedly NOT a lifestyle specialty. But I guess you have to do what you love, even if it doesn't necessarily have hours you love.
Sunday, November 2, 2008
Bob the builder! Yes he can!
Scoop, Muck and Dizzy…….”
So today I sang the entire theme of Bob the Builder….. while doing a pap smear. My patient was a stay at home mom, with no one to watch the kids. She attempted to keep the pacifier in her baby’s mouth while I did my best to “entertain” a four year old boy. Which entailed singing, while I inspected his mother’s nether regions. Later, I had to push him away from the biohazard trash with one hand, while hold “specimen” in the other. This is pretty much the norm. I guess this could be one of my multitasking skills.
My patients often have to bring their small children to their appointments. I have great sympathy for this having hauled my own boy genius around a few times. So I often find my self trying to help them entertain their children while I ‘m doing their exam. Whether it letting the kids hold the Doppler to listen to the baby’s heart beat or in depth discussions about Thomas the Train.
“I see you like Thomas?”
“Yes, my favorite engine is James”
“No that ‘s not Thomas your holding, that’s Gordon”
“No, Thomas doesn’t have a coal car, and he’s #1 Gordon’s #4”
“Yes, I’m sure I’m right”
I hope my patient ‘s appreciate the effort … and don’t find it creepy that I’m singing the theme to Elmo's World while checking their cervix.
Saturday, November 1, 2008
But as a doctor-mom of 3, I am hopelessly behind. I frequently gush over movies I have seen over the weekend only to have people say quizzically, "You mean 'Walk the Line' that came out like 3 or 4 years ago?" Yeah, that's the one. I have made my peace with the fact that I will never catch up.
Anyway, I am ashamed to admit that I did not see the last Presidential debate (which took place over 2 weeks ago for those of you who are also 3 weeks behind on dictations and looking at 6 loads of laundry next time you can bring yourself to go to your laundry room) in real time. I recorded it to watch the next day--ha, ha, right! Anyway, I finally watched it tonight, before the election at least, and holy mackerel!
There is a moment in there where Obama and McCain are discussing abortion. Obama says, "I am completely supportive of a ban on late-term abortions, partial birth or otherwise, as long as there's an exception for the mother's health and life." McCain proceeds to offer his rebuttal and says IN AIR QUOTES "health of the mother", not once but twice. Here's a link to one video on youtube that shows just this brief exchange, rather than having to sit through the whole debate for those of you who were together enough to watch it in real time: http://www.youtube.com/watch?v=SGZOyxfiNoU
Whether you are Republican or Democrat or Independent, pro-choice or pro-life with or without conditions/exceptions, can any woman, particularly a woman in medicine, watch a potential future leader of this country put the "health of the mother" in air quotes during a mainstream media event watched by tens of millions of people without falling off the couch? I managed not to hit the floor, but just barely. And I'm posting at 1:30am because I cannot sleep for wondering the implications of such an attitude for the women of our nation.