Saturday, January 31, 2009
But what happens when that piece of the puzzle remains elusive? Where do we go? Most of us have a game plan for those cases that don’t seem to have any answers no matter where we turn. And often, our patients are satisfied with our attempts - even if no answer is found.
But what about the medical mystery that isn’t our patient – but the child of a friend or an acquaintance? What’s the best response when that friend asks for advice or an opinion? How much effort have you (or would you) expend in such a circumstance? I think that we’ve all expended some informal efforts regarding kids – an otoscopic evaluation here (a neighbor calls on a Sunday afternoon and wonders if a trip to the ER is warranted), a concussion assessment there (you’re at the playground and watch a child fall off the slide) – but what’s your comfort level regarding something that doesn’t seem to have an answer?
As with the mysteries mentioned above there many not be one specific answer (and certainly not a “right” or “wrong” response!), but I am interested in knowing your opinions when faced with this issue.
Friday, January 30, 2009
In the operating room, invariably, it is my rooms that get the fresh new scrub techs that don't know a Kelly from a Heaney clamp, because they don't want to tick the male doctors off. My rooms also tend to run farther behind, "because (I) don't throw a fit." I'm sorry, since when was "throwing a fit" acceptable professional behavior? It happens more often than it should.
The reminders extend to the floor, as I round on my patients. At times I have to search high and low just to find the nurse that is taking care of my patient. I see my male colleagues, without lifting a finger, get a nurse to round with them. No kidding, these nurses, with whom I have a very good rapport and professional relationship, will snap to attention, grab the physician's charts, and follow them on rounds writing verbal orders as they go. Boggles the mind. I am friendly with the nurses, but in high stress times, I tend to bark orders just like any other physician. I have been called out for being "too harsh" in certain circumstances, and made to sit down with the nurse in question to apologize. I tread very carefully in my tone of voice, in order to not be misconstrued. In contrast, there was an incident in which a male physician grabbed a nurse and *shook* her because she did not complete an order that he requested (in the best interest of the patient.) Today that doctor and that nurse were laughing and joking together like it never happened. I have to wonder if I would even be working if I had dared pull such a stunt.
In the office, the fun continues, as my front office staff gives me hell for cancelling patients for a delivery, but will turn around in a heartbeat and croon "Aw, poor OtherDoc (my male colleague) has to go for a delivery. Of course we'll take care of it!" When the office orders lunch, they serve it to him in his office! You know, because he has "important doctor stuff to do!" Not to mention the varied and sundry insults that seem to happen on a daily basis. Patients that call me "sweetie" instead of *Dr.* Whoo or refer to me as "that nurse right there." Office patients that insist on calling me by my first name (which I never gave to them). The visitors that come up to me at the desk while I am working on charts to ask me to go fetch them some ice. This never happens to my male colleagues. It just doesn't.
We've all covered, in detail, how the difficulties extend into our home lives as we struggle to wear the mother, wife, and physician hats simultaneously. Women in medicine may have come a long way (baby), but from where I stand, we are the Thursday's children of medicine. We have far to go.
Tuesday, January 27, 2009
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Monday, January 26, 2009
Of course, I'm not much like the upper east side moms in the movie who don't work but have a live-in nanny. I have a nanny because my husband and I both work full time. But that doesn't mean I don't feel guilty about leaving my daughter every day. Or become paranoid that she likes the nanny more than she likes me. We used to joke around that Melly liked our nanny best, then me, then my husband.
I returned to work from my maternity leave when Melly wasn't even two months old. I was forced to trust a complete stranger to watch my infant every day while I went to work. It all felt so pointless. Why did I have a child if I was just going to abandon her every day? This wasn't the way it was supposed to be.
The nanny was part of the reason I clung to breastfeeding as long as I did, even though my work didn't really allow me time to pump. I figured that was the one thing that only I could do for her.
As time passed, it became easier to leave my daughter every day. And thank goodness, Melly strongly prefers her parents to her nanny. (Even though our nanny is wonderful.) She cries when I leave but not when the nanny leaves.
Still, I can't help but feel a lot of guilt that someone is raising my child besides her mother.
Sunday, January 25, 2009
Friday, January 23, 2009
The report includes an evidence-based list of five simple daily habits for mental wellbeing. These activities, which are likened to five daily servings of fruits and vegetables, are recommended to every person in the UK:
2. Be active. Go for a run, walk around the block after dinner, putter in the garden or take the kids sledding.
3. Take notice. Be aware of the details of daily life - the beautiful, the humorous, the surprising. Be conscious of the world around you and your reactions to it.
4. Keep learning. Take a photography course. Learn to knit. Tackle a work problem in a different way.
5. Give. Show kindness to others. Volunteer. Support a charity. Donate blood.
The report, the result of a two year study involving over 400 international experts, concludes that making these five activities a part of daily life can have a profound impact on people's happiness.
These recommendations crystallized a few things for me.
First, they offer an explanation for why a day at the clinic is almost always extremely satisfying, whereas a day at home with the kids must be carefully crafted to provide close to the same level of happiness. I'm not talking about long-term gratification or blissful moments, where at-home mothering easily holds its own. I'm referring to my state of mind at dinner time, when I review the day.
Medicine has an advantage in that it inherently ensures that I connect with colleagues and patients, take notice of the details of others' lives, learn continuously and give to others. I tick off four of those five boxes just by going through my day. I check off all five when I hunt for free parking and walk eight blocks to the clinic.
Staying home with the kids, few of those five activities occur spontaneously. When the path of least resistance is followed, a length of time at home seems to naturally tend towards isolation, inactivity, monotony and boredom. Most of my days at home are pleasant ones, but only because of the work I put into making them so. Scavenging in the woods, photographing ruddy cheeks and muddy boots at the beach and meeting up with friends for afternoon tea at Honey's Doughnuts make for good days, but require concerted effort on my part.
Second, the list validates the time I take during the day for pleasurable pursuits. Knitting while the kids nap, bringing The Element of Lavishness along to the beach and fiddling with a setting on my camera during lunch are often accompanied by some guilty twinges. Shouldn't every moment with my children be devoted to them? And any spare ones be spent reading Parkhurst Exchange?
But I see that all of my hobbies include several of the five happiness-inducing habits: photography involves learning and taking notice; writing requires taking notice, connecting with others and learning; and gardening entails being active, learning and taking notice.
Now I can articulate why tucking away pockets of time for these activities during the day is not frivolous: it may quite literally preserve my sanity.
Thursday, January 22, 2009
How are my children going to remember me? Mommy, finally home from work, lying listlessly on the couch, book in one hand, computer near the other? This isn't how I want to be remembered. When I try to go and do kid-friendly activities, I find myself incredibly short tempered and longing for the comfort of home. I know that 4 days off a month is just too little down time, and things will get better once my job situation changes. In the meantime, what do you do with your little ones when you have the time to spend? Any suggestions for low key activities for 5 year olds and 18 month olds? I want to start making some good memories for my kids that don't involve the movie theater. Thank you in advance!
Tuesday, January 20, 2009
A lump began to rise in my throat.
“Well. Ummm. I’m not sure” I stammered.
We haven’t really discussed it. The truth is that two years ago when we started this adoption journey, I would have never dreamed it would have taken this long. We both assumed we’d have a toddler by now.
Our son has albinism. It is autosomal recessive genetic disorder. Our son is beyond amazing and is barely effected by the condition, however we know that a majority of people with albinism will be significantly visually impaired. When we decided to grow our family, domestic adoption was the path that seemed right for us.
It was exciting at first. We told everyone we knew about our journey, for their prayers and support. Additionally, the books (I’ve read many) suggested to network in case friends/ family knew a potential birthmom. We took classes and filled out paperwork it was a tendious process but at least we were “doing “something.
Then we waited.
We were a year into the process when we met our first birthmom. Things were amazing. We were so excited we could hardly stand it. We knew we should be cautious, but things seemed so certain. Then days before delivery things fell through not because she changed her mind, but because of a strange legal glitch. We were devastated and left staring at an empty nursery.
A few months later we met birthmom #2. She was very young and early in her pregnancy, still she seemed sure of her decision. Plus all the books say the averaged couple has “1” failed adoption. Of course we all know these things don't always follow the books. Four months later she changed her mind and decided to parent. This was hard, but we knew it was a possibility,
Yesterday, I got news that birth mom # 3 has backed out. This was a strange situation and I had little hope of it working out from the beginning. Still, part of me is left wondering, “Um… seriously God. What now?”
The irony being that I deliver babies. Constantly. This of course confuses boywonder. For awhile after the first adoption fell through, he would ask when I went for delivery if “it was our baby” I was delivering. No, not yet. And my heart would break just a little but every time he’d say it. He rarely says it now. So much time has passed. It’s also getting challenging to deal with all the follow up questions from the “zillion” people we’ve told.
At work its hard to be sympathetic to the patients who get upset about an unplanned pregnancy. The worst is people who get seriously upset about the gender of their baby. Honestly, I’ve never been able to muster much sympathy for them. I know that the process has given me a new depth of empathy for my infertilty patients and others going through challeging situations.
I’ve labeled this post adoption Journey Part I as a statement of faith that someday (hopefully soon) I will proudly post adoption Journey part II where I will post pictures of my beautiful child. Until then thanks for letting me vent.
I’m also thankful to fat doctor for sharing her successful adoption story and being so transparent through her process.
Monday, January 19, 2009
Here's an example - my husband's grandmother (Ma) is visiting. She has a very strong personality. I love her and I'm absolutely thrilled that she is visiting, especially for my children. I'm pregnant and have now revealed that I will be having the boy who will carry the family name. (I'd like to believe this is an irrelevant point but given the generation gap, I'm pretty sure it contributes). Very soon after she arrived, Ma gave me a stern lecture about carrying my kids. I have a 2-year old and a 4 year-old. Neither 'have' to be carried but you all know how it is....sometimes they just want 'up' and sometimes you just want to carry them down the stairs because it's SO much faster. I said very little but she had a lot to say. "You're the doctor, you should know that if you carry too much weight, the baby will come out."
I should give more background - back in the day when she was in her 30's and 40's she was a midwife. She continues..."I saw many women who lost their babies because of placenta problems and stress on the body. You must not carry the children! Learn to say know and ask for help"
This is easier said than done. My husband is currently travelling for two weeks, I'm alone with the kids and it's virtually impossible to avoid carrying them for one reason or another. So I continue to carry them, only with the additional voice of guilt from Ma playing in my mind.
On the one hand, I want to respect her experience in life, she's lived many more years than I have. But the doctor in my mind is saying "nowadays, we have ultrasounds so I know where my placenta is and I'm really only putting my own back at risk which is a calculated risk in the moment!"
Perhaps if I didn't know better, I would be more worried about the baby, I'd ask more for help, or arrange for hired help and life would be easier? I can't decide if my medical knowledge is a blessing or a curse.
I've tried to respectfully tell Ma using few words that the baby is not at risk when I carry the kids but she still glares at me when she sees me holding my 2-year old even for a minute...Putting on my Mom-hat, I respectully put my daughter down and look around for help.
Yesterday, four year old Z spied my IUD pin on the lapel of my white coat. “Mommy!” he exclaimed, excitedly. “You have a POGO stick on your white coat!”
I smiled at him. “Why, yes I do!” Four is not age appropriate for methods of birth control. We’ll get there, don’t worry. Besides, why spoil his fun?
“Mommy, you bounce on those!” (Insert joke here). “But, you have to hold on!”
I was laughing so hard I could hardly drive by this point.
“Mommy,” he said, seriously. “I want a pogo stick when I’m a big kid.” Oh, you may get one, Z, but it will probably be a little different than the one daddy bounces on currently.
Today Z and I were talked about how he misheard something I had asked him to do. I said “I think it’s because you have elephants in your ears,” borrowing a joke from his pediatrician.
“I do not have elephants in my ears, I have little drums,” said Z, indignantly. I started giggling and, was of course, looking at his ears and spied a little stray wax. So I started to do the unfightable mom instinct thing and stuck my pinky in there to get it, and Z said “No! Don’t take my drums!”
(Cross-posted at Mom's Tinfoil Hat.)
Friday, January 16, 2009
Sometimes parents believe that medicine is a club – one that you can join if you have the right political affiliations or money or a very important job. Membership in this club gets them exclusive bonuses –kind of like frequent flyer miles or box tops – bonuses that include a physician’s home phone number or pager and the right to call them any time of day or night. Occasionally a parent will ask for my direct number- sometimes with a smile or a giggle as they promise not to call me at 2 AM for a diaper rash or spit-up. Acceptance into this club also allows members to talk about their child’s sex education in Starbucks, or ask for antibiotics (just in case) whenever they are leaving the country for Turks and Caicos for the next two weeks.
Being truthful with myself, I accept that I am part of a club of sorts. When my triage service calls about a family friend who bit his tongue and needed advice about whether to go to the ER or not, I call the family because they‘re friends, and they would show the same concern for my children. I’ve also referred my brother-in-law with appendicitis to Dr. Ileum because he’s a friend and I know he’ll take good care of my relative. I’ve also met a fellow partner and her child in the middle of the night when she suspected her daughter had new onset Type 1 diabetes. (She was right!) My family and close friends (I can count the number of families on one hand) are default members, and they know there are rules about membership.
The notion of an exclusive membership or concierge medicine doesn’t sit well with me. As humanly possible, I try to treat my patients as well and equally as I would treat my own family or friends regardless of socioeconomic status. There are boundaries, though, and limit pushers that make me put my foot down. I won’t write prescriptions on the fly for administrator or staff’s children anymore when I’m trying to make hospital rounds. It’s not fair to my patients to get distracted like that. I cannot prevent a patient with lice showing up on Sunday morning on my front porch, but I won’t let them expose my kids. My phone has caller ID, and we screen the calls heavily, so when I’m not on call, I’m focused on my family, and my personal time. It’s all part of a balancing act that I’ve had to learn bit by bit.
Tuesday, January 13, 2009
A few days later, I decided to take stock of how I was doing as a mom by sitting back and observing my own kids' behavior. Unfortunately, in the span of an afternoon, I heard my 5 yr old son telling my 3 yr old daughter, "I am closing my eyes and counting to 10. If ALL of those toys I just cleaned up aren't back in the toy box again when I open my eyes, we are not going to California next month..." or worse, my 3 yr old telling her teddy bear, "No, I can't play right now. The house is a mess, and I am busy!" with a familiar tone of irritation. Yikes! I think this reap what you sow business is the real deal.
This past weekend, I came down with a terrible cold. My kids had a friends' birthday party to attend. They had been looking forward to it all week. As I sat there coughing and feverish on the couch, I had to tell them I couldn't take them to the party because I didn't want to get all of the party guests sick. I braced myself and prepared for the fallout--here come the tantrums, I thought. They looked at each other, then walked out of the room silently. Two minutes later, they reappeared. My 5 yr old son was lugging a huge flannel quilt and a cup of water, and my 3 yr old daughter came bearing her favorite stuffed animal and her blankie. Together they worked, their tiny faces concerned but reassuring, their body language unhurried, gentle, and kind, to wrap me in the king-size quilt. My daughter put her bear and her blankie under my chin, and my son pulled the coffee table a little closer so that I could reach the cup of water without having to get up. Then before going off to play quietly with her brother, my daughter kissed my hot forehead and said, "Shhhh, I love you. You'll feel better soon."
And she was right. I did feel better. For all my shortcomings as a mother, and there are many, I am teaching my kids by example to be healers, at work and at home. For that, I am grateful.
Monday, January 12, 2009
It's also much more enjoyable for me as the reader since I'm not as often bored out of my gourd.
We have a couple of doctor-themed books in our house, hoping to give her a better idea of what mama does when she goes to "work." The books are okay, but rather uninspired. Yes, they have protagonists who are doctors, but that's about it. Neither she nor I is excited to read either of them.
But, then we found Doctor Ted by Andrea Beaty and Pascal Lemaitre. It is adorable. Funny. A great cadence to read aloud. Well-illustrated. It has quickly become one of Jolie's (and my) favorites.
Ted is a bear who wakes up, bumps his knee, and decides he needs a doctor. In the absence of finding one, he becomes one. The story follows his adventures of doctoring the people around him at school and at home, brilliant diagnoses included.
His mother was in the kitchen.
"You have measles,"
said Doctor Ted.
"We should operate."
"Those are my freckles,"
said his mother.
"Eat your breakfast."
Loving this book.
*I received no compensation for this! I just adore this book and thought other Mothers in Medicine might too.
Thursday, January 8, 2009
Daughter, on the other hand, is a healthy full-term infant and she is waking up.
Now two days shy of six weeks, she smiles. Usually this happens in her sleep and it is fleeting at best. Occasionally, I catch her smiling when looking at someone or something, but when I call someone over to see it, the smile disappears. She doesn't have a responsive smile yet, but it is so beautiful when it accidentally happens. You may call it gas, but her "gas face" is decidedly unhappy.
She can push her head up when on her tummy and when she is on her back she rolls almost onto her side.
If she could, she'd be held 24/7. She balks at the swing and bouncy chair, but after she cries a bit she seems to realize, "Hey, I like this!" Mama loves the swing and bouncy chair so she can
This morning, at Son's ophthalmology appointment, she picked up on my tension as Son wasn't 100% cooperative with the exam. I picked my screaming daughter up from her carseat and held her against my chest as I willed myself to relax. I felt us both melt into each other and, as we both grew calm, so did Son.
The doctor told us his exotropia is gone and his astigmatism is improved. She said we can reduce the patching to 3 days per week. I realized I was upset not that Son wasn't a perfectly behaved preschooler, but that he might have a vision deficit.
I still have numerous mothering lessons to learn, and this baby of mine is going to help me along the way. I wish I'd had the maturity to realize when Son was teaching me his own lessons. In hindsight, there were many.
Med school, schmool. I'm getting the best education in human development from mommyhood experience.
*cross-posted at Fat Doctor.
Wednesday, January 7, 2009
My attending is super nice and when I told her I had been doing this yesterday, she commented, "Oh no! But you could be pregnant!"
"Uh, no," I said. "I couldn't."
"Are you sure?"
She contemplated this for a moment, then asked, "Well, why not?"
I'm not sure why it's so shocking that I wouldn't want to be a resident with two babies. I don't hate sleeping that much. Do I look too relaxed?
During my first few months of motherhood, I couldn't imagine how ANYONE would EVER even consider having a second child. Every time I put on my non-maternity clothes, I cried with joy. But now, almost two years later, I feel the baby fever starting up again. Babiez r cute. So tiny and helpless. And breastfeeding was such a good way to lose weight.
And there's peer pressure. Tremendous peer pressure. Everyone seems to be having their babies two years apart. That way, the babies can be friends? All the women I know who were pregnant when I was are now pregnant again. Now is the time. Everyone is doing it!
My frontal lobe is still in charge for the time being. I love the fact that my daughter sleeps through the night and is more interactive and fun. I love that I still get to have some time to myself. If I had another newborn, my life would get crazy again. They say that a second child quadruples your work. If I were pregnant, I'd probably be too fatigued to be as good a mom as I want to be. And I'm not even 30 yet, so theoretically I've got a little time left on the old biological clock.
In the meantime, I've got to get myself a niece or nephew or something. A newborn that I can cuddle with for a short time then give him back.