Monday, July 13, 2009

Guest Post: On the lack of women mentors

None of my mentors have been women. It saddens me to say this. In fact it outrages me. The women I met in medicine prior to medical school warned me away from medicine - "Its not too late," they said. "You can quit now and find something easy." I had been bitten by the bug and there was no way I was doing anything else but medicine.

We had had real tragedy in my family and at that point I wanted to be a trauma surgeon or a neurosurgeon working 100 hour weeks, hopefully saving some lives, and the idea that I might want to do anything else with my life was so foreign.

Then at the end of 3rd year I got pregnant. We had been married 7 years. This was a planned and hoped for pregnancy and though I had thought that making the work-life balance would be difficult, I was definitely living a fantasy. Reality set in 9 months later when I held my child in my arms the first time. The responsibility weighed on me. I almost picked my specialty just on the fact I could have an easier residency. But I decided not to sell out my dream.

I am lucky and have an incredible husband who can (and will) be doing the parenting by himself next year. I chose to stay in town at an academic but not abusive residency. I've got a long road to go, but I realized long ago that it is about the journey and not the destination.

I wish there had been a woman around who had made the same decisions I made who seemed genuinely happy about them. Maybe I'll find one as an intern/resident. There are definitely some women out there who could use some guidance other than "Don't do it."

A reader left this comment a few weeks ago on a post that was part of our Topic Day on "Our Mentors." We hope this site can be a source of support and encouragement for those who need it. (I think all of us contributors here agree that it is worth it, and our lives are richer for our decision to be physcians and mothers.)

Saturday, July 11, 2009

I Didn’t Join the Circus, So Why Must I Jump Through These Hoops?

One of the things that troubles me most as a teacher is watching medical students’ enthusiasm and curiosity deteriorate during medical school. Within about three months, I see them going from thinking about what they are learning to trying to pare down the material to what is likely to be on the next test. The competitive habits that got them into school provide a deeply debased motivation for studying—without knowing why, they fret about being AOA or getting into a competitive specialty . Few of them live in the present—as preclinical students, too many want only to survive to move to the clinical years. As clerks, they worry about buffing up their records to get into residency. Once in residency, I wonder if they ever recover the vitality that comes from being fascinated and engaged in learning something, thinking a new thought, or enjoying the unfolding of a new relationship .

Given the deadening effect of our current way of educating— or to be precise, training—doctors, I understand why the competing challenges of mothering appeal so strongly. With children, we have to live in the present (though we do also eventually transmit to them worries about their future and risk turning high school into nothing but a springboard to college). We can’t stop to study them for the next exam. Their development and our relationship to them propels us forward, and it is only in looking back that we see how much we may have learned in the last few days, weeks, months or years.
A lot of paper and ink is currently wasted by people pontificating about “adult learners,” postulating that they learn differently from children—because they have to incorporate new information into older structures and because they need to learn by doing rather than by rote. I often find myself doubting whether any of these theorists (mostly men, I might add) have actually watched children explore the world, puzzle out new information to figure where it fits with what they already know, and joyfully practice new skills.

I wish that I could be creative and persuasive enough as a teacher who draws on experiences as a mother to enlist others to think differently about how to engage and encourage students . Rather than spice up our lectures with video clips to entertain them, we should think about creating relationships with patients, peers, and mentors that both stimulate their felt need to learn things and reward them, immediately, for doing so. I know that a medical student will never learn the complexity of our profession in the unselfconscious, apparently effortless way that our children learn in their early years, but I think they long for it to be so, and I long to able to make it that way for them. But even if that is not possible, we need to think more about motivating them by stimulating curiosity rather than fear of failure, rewarding learning immediately rather than in the distant future, and engaging with them as teachers so that they in turn will engage with patients and be the doctors we would want to see when we get sick.

Thursday, July 9, 2009


I made a post a couple of months ago about how impossible it is for a mother to do a fellowship. I feel a little embarrassed for acting like Whiny McWhinerson, especially since it turns out I landed a fellowship after all. Apparently, after residency it's all about the connections and I had the right one. Woo, I get to continue being an impoverished trainee! (Just kidding, I'm actually really psyched.)

A large component of my fellowship is supposed to be "flexible research time". This really appeals to me, not because I intend to spend this time taking my daughter to the park, but because I love doing research. Many eons ago, during college, I participated in quite a few serious research projects, but the mice in the lab weren't my bag (baby). I love proposing a project, collecting data, analyzing data, writing the paper, and especially seeing the article in print... but I hated sitting in a lab with test tubes and/or rodents. Ugh, and PCR.

So the idea of doing clinical research really appeals to me. People all tell me I seem like an academic. And it's in my blood (i.e. both my parents).

I also think that it's ideal work for a mother in medicine due to the flexibility. I never want to give up seeing patients or lose my clinical skills, but I think I'd lose my mind seeing patients full time. Research grants seem like a nice way to add to your income while not working yourself into the ground. Also, you have the opportunity to contribute something to your field as a whole.

I haven't seen any other MiMs on here discuss research as part of their job. An oversight or does it just not exist?

Wednesday, July 1, 2009

Ladies, don't panic!

Just a couple days ago, I posted about the decision my husband and I are struggling with about whether to try to have a fourth child. The piece got a lot of comments. The one that struck a chord the most, though, came from an anonymous reader who commented:

"At the risk of being the Cassandra here, how well would your life work with a fourth child who has Down's?? You know how high the odds are climbing for you at age 37. Your family size is clearly not my decision, but in my family of origin I was the youngest by a large margin, and my parents wanted a sibling "for me" close in age. My un-named baby sister had Downs and its most severe cardiac manifestation when she was born via emergency C/S to my then-37 year old Mother. She never left the hospital, and her death tormented my Mother the rest of her life. And selfishly, I know if she had lived MY life would not have been the same. Just some food for thought...."

First, let me say that I think Anonymous' intentions were good, and I appreciated the willingness to share a personal story to provide the devil's advocate viewpoint to the general tone of "Keep the love goin'" comments I was hearing. But the truth is that that comment struck fear in my heart. I immediately thought "She (or he?) is right! We have been so fortunate to have 3 healthy kids. We should quit now." And then, "Actually, no, I don't know 'how high the odds are climbing' for me at 37." I know that 37 is advanced maternal age, but I had no idea what 37 really meant for my risk in cold, hard data. So I did what I always do in moments of personal medical crisis--I did research and I called my baby sister (not an MD, but a pediatric physical therapist and a voice of reason).

From a career standpoint, I wear two hats--one as a clinician treating breast cancer patients and one working in a public health role. For both, I spend a lot of time thinking about risks and how we convey them to patients and people in general. What is most understandable by a lay person? How do we shape perception of risk, and in turn behavior, when we express risks one way versus another? It is fascinating and, at times, disturbing.

Note that, due to some formatting challenges for my elderly brain at 12:30am, I am indicating risk of Trisomy 21 in bold and risk of any chromosomal abnormality in italics rather than figuring out why my tables come out garbled in the post.

Maternal age Risk of Trisomy 21 Risk of any chromosomal abnormality
25 1 in 1250 1 in 476
30 1 in 952 1 in 384
33 1 in 625 1 in 286
35 1 in 385 1 in 192
37 1 in 227 1 in 127
40 1 in 106 1 in 66

For any of you who aren't 25, I am guessing this looks pretty scary. I know I can feel the sand slipping (or more accurately, gushing) out of my hourglass when I look at that table. But now what if I put it like this instead? (Same formatting convention with the bold and italics, but note the difference in the headings)

Maternal age Chance of NO Trisomy 21 Chance of NO chromosomal abnormality
25 99.92% 99.78%
30 99.90% 99.74%
33 99.84% 99.65%
35 99.74% 99.48%
37 99.56% 99.21%
40 99.06% 98.48%

Kind of takes the zing out of it, doesn't it? For those who don't know, 35 is called Advanced Maternal Age because that was the age (historically...amniocentesis is a bit safer now than it used to be) at which the risk of fetal loss due to amniocentesis was approximately equal to the risk of detecting a chromosomal abnormality, and therefore, the benefit of prenatal detection was felt to justify the inherent risk of the procedure. The fact is that, at the large academic medical center where I practice, they now consider advanced maternal age, for those purposes, to be 32 and routinely offer amnio to women who are 31 or older at the time of conception. This has caused all sorts of angst and dismay amongst the female residents and fellows who feel that they are now somehow at higher risk because of this change in definition. One physician even lamented to me: "It's not fair. How come advanced maternal age changed to 32 for us? I thought I still had 4 years, and now I only have 1!?!" Ummm...because amnios are safer.

Now, don't misunderstand me. I am not on a soapbox to get everyone to delay childbearing willy-nilly into their 40s and 50s. That is the terrain of Hollywood stars. For every successful story you hear of someone who had all 3 of her kids in her 40s with her own eggs and got pregnant in a month each time (and those people exist, for sure), there are also many, many often untold stories of women who endured multiple miscarriages or fertility treatments, who tried to get pregnant unsuccessfully for years with all the heartbreak that involves, etc. But the fear of Down's syndrome, or any other chromosomal abnormality, should not be what drives someone to get pregnant (or not).

So, as I said, I also called my sister to get her take on all of this. Wise as always, she said something that really hit home for me. She has a clinic brimming with children who have physical and cognitive challenges of every variety, including Down's syndrome. But, far and away, the most common cause of the disabilities she sees are things that happened after birth: near-drownings, meningitis, head injuries from biking without a helmet, car accidents. Patients with Down's or other chromosomal abnormalitites represent a minority of her practice. Which brings me to my next point: there are no guarantees in life or in parenting. To be clear, I am all for prenatal testing. I think it is critically important for couples to have the opportunity to know before birth if their baby has a chromosomal abnormality, whether that allows them to make the agonizing choice to terminate a pregnancy or to prepare for how their lives will change with the addition of a special needs child. But it's not a guarantee of a "normal" child. There are plenty of things that can't be tested for prenatally, and there are plenty of things that can go wrong--both diseases and accidents--after birth that will change the life of a child...and his siblings...and his parents forever. One of my own best girlfriends from college is currently struggling to come to terms with how their lives have changed since her previously healthy and incredibly athletic 7 yo son had several catastrophic strokes for which no explanation has been found. That uncertainty comes with life and with parenting, and if such uncertainty is too much for an individual to bear, parenting is going to be a very long, very hard road.

Everyone always says that pregnancy prepares you for being a mother--the sleepless nights of back pain and leg cramps and inability to breathe and peeing and rearranging closets during pregnancy are training for waking every 2 hours to breastfeed ad infinitum, to comfort the colicky baby who cries half the night, etc. The truth is that the lost sleep of pregnancy is just the tip of the iceberg compared to the lost sleep with a newborn. Worry is no different. You will no doubt worry as a woman trying to conceive and as a pregnant woman, but I can tell you from experience that you will worry a thousand times more once you are a mother. It is understandable. It is probably evolutionarily conserved so that our species will survive. But it cannot be all that you do, or it will become all that you are.

So ladies, don't panic!

The Other Side of the Gurney

What happened?
I feel wet grass and mud on the back of my head and a searing pain shooting through my body.
Where’s my son?
I feel a sense of relief when I call out to him and he says he’s fine.
Can I move my legs?
Do I have to go to the ER?
How am I going to get there?
Husband’s not home.
Can’t believe this happened.
Can’t believe I don’t have disability insurance yet.
I remember my neighbors were outside a minute ago.
NEIGHBORS!!!! I need help!
They rush over.
I’m not sure if I can move.
They help me up.
Throbbing headache, but everything works.
Neighbor takes me to ER, other neighbor keeps son.
Head injury gets me quickly into ER bed. I lie there lonely, thinking of worst case scenarios. Praying. Husband is on his way home, will be here in an hour. Call up to Labor and delivery to see how busy they are, they sound slammed… I don’t tell them why I called (hoping they were slow and someone could come down and sit with me while I wait)
ER doc is really nice. I recognize his voice from many phone calls.
So what happened, he asks.
Fell off trampoline, landed on the ground, on my head. The “safety” net broke.
Let’s get a collar on you and a CT scan.
I tell him the irony was we have scheduled to get rid of this trampoline the next week. It had came with the house and was getting old.
He chuckled.
I didn’t.
Then the orderly (I think they call them ‘tech’s now) wheels me through the hospital to radiology.
The whole thing feels surreal. I’ve walked these halls hundreds of times, but I’ve never looked at the ceiling. It’s a normal ceiling.
Strange to be on the other side. I fell anxious and embarrassed.
More than anything I feel vulnerable. Being pushed around the hospital. Flat on my back. Unable to move. Wearing only a hospital gown and underwear.
The tech tries to make small talk, but no one explains anything because they assume I know.
I see people doing double takes out of the corner of my eye. Is that Dr. RH+? Why is face tear stained and her hair wet and muddy?
The CT doesn’t take long just a few minutes.

Another trip through the hall and hubby arrives.
We’re both relieved to see each other.
ER doc gives a good report.
Headaches and neck pain for a week, but luckily no long term injuries.
Hug son extra hard when I get home.
I feel blessed.

Monday, June 29, 2009

Are we there yet?

I have 3 kids ages 1-5. I have taken 4 flights alone with said 3 kids in the last month, so I find myself attempting to answer "Are we there yet?" often lately. But guess what? I'm actually the one who has been asking it and not just because I was READY to get off that plane (though I was READY to get off that plane, too). My husband I are struggling with our future childbearing plans. With 3 kids, is our family complete...or not?

Now ordinarily, I'm not a huge fan of the overshare and I wouldn't take these musings to a blog of physician mothers, but it feels relevant here.

My med student brother-in-law and his wife and two little girls were visiting this weekend, so I had to drag out the high chair and the pack n play and all of the baby stuff that is still stowed in our attic. And while I had a little familiar wave of nausea as I watched all of our floor space become occupied by clutter, as it has been for so much of the last 5 years, I also had a little wave of nostalgia. Actually a big wave of nostalgia. We are long overdue for a yard sale to be certain. But am I really ready to give away the bassinet? The baby tub? The smallest baby clothes? The boy baby clothes that I haven't had occasion to pull out since my first child was born 5.5 years ago? I'm not so sure.

My son would love to have a brother (no guarantees there, of course, but as a woman who can't imagine not having a sister, I do give a nod to his desire for a brother). We have the space--two of the kids would have to share a room, which none of them do right now, and I'm sure that would generate discord and some night time awakenings, and we would need to trade one of our cars in for the dreaded minivan--but we have the space. More importantly, though, we have the space in our hearts. We love each of our kids more every time we have another one. I know we would be busier, which unfortunately detracts from the individual time each of our kids get with us, but in exchange, they would get the love and companionship of another sibling, and that counts for a lot. And when my husband and I are long departed from this life, it will count for even more.

So why am I struggling? Well, the truth is that it wears me out to think about having to "start over" yet again at the career. Having to make excuses about being late because the baby kept me up all night and then I slept through my alarm. Having to take breaks from meetings to pump. Having to rush out of clinic and skip tumor board in order to see my baby before he or she goes to bed at an insanely early hour that is currently referred to as "dinner time" otherwise in our household. Having to turn down awesome opportunities and excuse myself from obligations because deadlines or conferences will occur when I am 36 weeks pregnant or when I have a 6 week old. And, most nebulously but maybe most significantly of all, having to prove that I can "still do it" as I had to prove I could still do it when I was pregnant as a first year fellow; when I had two children and therefore two maternity leaves during the course of a 3 year fellowship; when I got pregnant with my third child shortly after starting my new job. Presumably, this time it would be having to prove that I can still do it even though I now have 4 kids since I have been told many apocryphal stories of physician moms who "cut back to part-time when they had their second and then decided it was just too much and quit working after the third." I don't know what happened to them when they had their fourth. Maybe I don't want to know!

There is definitely an assumption at our jobs that we are done since we have 3 kids. I have had multiple colleagues tell me jovially and empathetically, "Hang in there. It's going to be so much easier in another year or so all of your kids are out of diapers!" It is a forgone conclusion that we are done to everyone except us. We have already exceeded the magic number (that would be 2) of kids for the two-physician family. On the other hand, I was recently told by a former med school classmate who also has 3 kids that "3 is the new 2". The question that leads me to is: So, does that make 4 the new 3...or is 4 still 4?

But the bottom line is that I just turned 37 a few days ago, and I have 3 small kids. If I am going to have another, I want to get on with it and soon. I would rather keep going with the diaper stage than have to go back. I don't want to be facing paying for college tuition at the same time I am also trying to retire. I want to be able to do things like go camping and hiking as a family, things that are harder or impossible to do when there is a baby or toddler straggling and holding back the rest of the group. I want to be able to plan days without having to accommodate anyone's nap. And I want to do it while I still have the energy to survive sleepless nights and chase my kids around the yard after a full day of work. So while I am not sure what our decision will be, I think the time we want to make it is soon.

So, are we there yet?


Usually I try not to post twice in a row, but I'm angry about this now.

On my way out the door on my last day of residency, I was chatting with two male junior residents about how much I enjoyed residency and wouldn't even mind if I had another year left. This may be selective amnesia on my part and I probably deserved to be smacked for saying that, but I love my field and I thought (most of) residency was awesome.

However, as I spoke with these junior residents, I got the distinct impression that they thought the only reason I enjoyed residency so much was that the attendings have been favoring me.

They cited the example of an attending that I will call Dr. Smith:

Dr. Smith has a reputation, in general, for favoring female residents. Several (but not all) of the male residents dislike him and say that he gives them a very hard time. A few residents were annoyed that he didn't make me go to the grand rounds that took place once a week at 6AM. Dr. Smith told me: "Fizzy, I know you have a baby and you've got a lot on your plate, so since you're not going into my field, I don't want to push you to do this."

I overheard another resident complaining that Dr. Smith didn't force me to do this once a week afternoon clinic for the undergrad students (note: don't talk shit about someone when they're standing three feet away). It is true that for the first month of our two month rotation, I didn't have to do the student clinic, but the underlying truth was that there was no school that month so there were no patients. The second month, when school was in session, I worked at the clinic. Yet a couple of residents insisted that my month free of the clinic was all because of favoritism.

I worked hard on that rotation to impress Dr. Smith, not by kissing up but by having a strong knowledge base. My shining moment was when I was doing a procedure with Dr. Smith and he was pimping me nonstop through the whole thing. Finally, after about half an hour of pimping, he said to me: "I can't stump you, can I?"

It bothers me that other residents think that I've been favored because I'm a mother. Just because I enjoy residency, it doesn't mean I haven't worked hard. If I've received any favoritism, I'd like to think it's because the attendings know I'm hard worker. I also study my ass off. We had two major exams this year and I got the highest score on both by a large margin.

A friend told me that any time an attending likes a female resident, all the men will say it's because that attending favors women, not because she's actually a good resident. I'm beginning to wonder if that's true.

Monday, June 22, 2009


It's official: I've graduated from residency.

We had our graduation dinner last week. I was anxious about it all day and my husband kept asking me why. Somehow it wasn't a good enough explanation that I was scared my two year old daughter would scream her head off during a ceremony attended by professionals in my field that I highly respect.

One other graduating resident had a child and we conspired to sit at the same table, thinking that at least this way, nobody would be able to differentiate one screaming child from another. Right off, things didn't go well when Melly didn't seem to get that she was only supposed to clap when everyone else was clapping. Neither of our girls made it through the ceremony and our husbands had to take them outside. Apparently, her husband said to mine, "So this is what our lives have become."

In general though, I was very proud of how well Melly behaved. As long as there was food in front of her.

I'm proud of myself too. I still think of myself as very very early in my career, but when I see high school kids shadowing our doctors, I realize that I've come very far. They've still got to graduate high school, go through all of college, take the MCATs, go through med school, take Step 1 through 3, do internship, and do residency in order to get to where I am right now.

It was not easy. I am a little ashamed to admit how many times I came close to quitting. There are a lot of people who started med school with me in 2001 that have been lost along the way... they will not be graduating now or ever. There are so many ways to get tripped up on this journey: students who flunked out, switched into other fields, quit to raise children instead, or worse, are no longer with us.

But I made it. I'm licensed to practice medicine and will (hopefully) soon be board certified.

So has anyone warned you not to get sick in July?

Wednesday, June 17, 2009


I really, really don't like to post about political topics. Mostly because it is inflammatory, but also because, to me, it is extremely personal. However, based on recent media coverage, and President Obama's recent remarks to the AMA, I feel that I cannot keep silent on this subject. In his recent speech to the AMA, he downplayed the importance of tort reform in decreasing rising medical costs (such as unnecessary, expensive tests, ordered primarily to CYA and keep the lawyers at bay). More disturbing, however, was the notion that, in a "public option" (aka Government-run plan) he would base physician rating and reimbursement based on their personal health outcomes.

So, wait a minute, what's wrong with that? You ask. I mean, it is the doctor's *job* to make you *better,* right? It doesn't seem so have a cold, you visit your physician, s/he diagnoses you with a viral infection, you get better, life goes on. But, what about this? As a physician, your patient population is obese. Despite your multiple attempts and counseling and lifestyle change recommendations, your patients continue along their unhealthy lifestyle, becoming even more obese. Guess what? You get a pay cut. Your patient that has smoked a pack a day for 50 years, and laughs in your face at your attempts to counsel smoking cessation develops COPD. Sorry, that is coming out of your hide. You did such a *bad* job of taking care of this patient! Your diabetic patient doesn't fill their medicine for a month, and then comes in to the hospital in frank DKA. *Your* fault for a negative outcome. Then, to add more fun, your ability to order laboratory/imaging tests will be limited (in the interest of keeping costs low), but if you miss out on a diagnosis? Your *fault,* and here come the lawyers for their piece of your livelihood. Where is the personal responsibility?

Who wants to put up with years of rigorous training, difficult study, and mountains of student loan debt only to be stymied in patient *care* at every turn? Surely not our best and brightest. I am worried about the future of our profession. A "public option" (not "free," by the way, more like $62,000 taxpayer dollars per person) for all intents and purposes will likely undercut any private competition (not to mention the tax burdens that will be levied to discourage competition). This will leave us, both patients and physicians, with only one choice. Government Medicine. Just like Government Motors. I don't want to become a government employee. I don't want my health care options to be limited to government employees. I don't even like to spend a day at the DMV!

I do believe that some reform, obviously, is needed, but I think it needs to be more geared to catastrophic coverage. I think we need to go back to fee-for-service health care, even schedule fees on a pro-rated percentage based on income to make health care visits affordable for all. Get rid of insurance for preventative care, labs, and office visits. Competition will then drive the costs down naturally. We, as physicians, can stop shuffling through piles of insurance paperwork and prior auths and get back to doing that which we were trained to do. Something that we love to do....take care of patients! Personally, I feel that "free" = "of little value." I believe we need to give people back a financial stake in their health care, and, perhaps, when they are financially vested in staying healthy, then they will value their health, and their health care providers, once again. Until then, I jump through a few more hoops to get my patients the care they need, and I worry about the future of our profession, and our nation.

Monday, June 15, 2009

Elizabeth Blackwell is rolling in her grave

When I was in grade school, we did a one week segment on human biology. What I remember about grade school human biology was that our teacher would write a bunch of information on the blackboard and we'd copy it down and then memorize it. By the way, did anyone else really really hate copying things verbatim from the blackboard? It seemed like something we had to do an awful lot.

At the end of the one week, we would select three pieces of paper from a bag of questions, and we'd have to answer those questions in front of the whole class. If we got all three questions right, we'd win a prize. For the girls, the prize was a book about Elizabeth Blackwell, the first female doctor. I had like four of them by the end of grade school.

(FYI: I remember one of the questions was, How many bones are there in the human body? I no longer know the answer to that question. I was smarter when I was six than I am now.)

Anyway, fast forward fifteen years into the future. I am at a med school interview and I get asked a really dumb question by the interviewer: "If you could have dinner with any person, living or dead, who would it be?"

That's such a stupid question. Honestly, if I could have dinner with any person, living or dead, it would probably be my husband. I like having dinner with my husband. If I were having dinner with, like, George Washington, I'd probably be really nervous. And creeped out, because he's dead. I'm sure I wouldn't enjoy the meal very much.

(A better question would have been, if I could FIGHT any person living or dead, who would it be? I'd fight Ghandi.)

So I had no clue what to say, but I remembered that Elizabeth Blackwell book, so I said, "Elizabeth Blackwell. Because she's also a woman in medicine and she understands the obstacles we have to overcome."

Oh man, good answer, Fizzy! Except for the fact that I've spent the last nine years kind of feeling like a tool for saying that. I mean, it was just the lamest, most untrue answer I could have given. I don't actually want to have dinner with Elizabeth Blackwell. I was just trying to come up with an answer that would impress the interviewer. (Although actually, maybe it would be fun to talk to her about arrogant male doctors.)

The worst part is, that med school went and rejected me.

Friday, June 12, 2009

MiM mailbag: NP or MD?

I am a 30 yo woman who finally got up the nerve to pursue medical school after dreaming/obsessing about it for 15+ yrs. I'm planning to start a post-bacc program next May. But now that I'm 30, I've realized that I do want to have kids, soon, and I don't want to miss the most exciting years of their lives. Although becoming a Nurse Practitioner has never been a goal of mine, I'm wondering if you Mom MDs think it would be worth it to settle for a career as an NP in order to have more time to spend with my kids. Thoughts?

Wednesday, June 10, 2009

When EBM is not enough...

I recently had my third child (he's 7 weeks today) and he's a boy - which is a new experience since my two others are girls. Among the various new challenges (which include changing diapers - I've managed to get sprayed on more than one occasion) one unanticipated challenge is what to do with the vaccination schedule? Since my 2 older children are girls, I didn't really worry about autism - but now that I have a son, I find others are asking what I will do?

Well, I started to answer this question with my EBM skills - I looked up the evidence to support any change in the normal practice and of course, there is no good evidence right now. However, now that I have engaged my many Mom friends on this topic, I have heard many, many anecdotes of parents who are sure that a known case of autisum was related to the vaccines given all at once.

Next week, my little one is schedule to get 5 vaccines at once - 4 injected and 1 oral. With all due respect to EBM, while there's no good evidence to support any interventions, I've decided to give the vaccines over 2 visits, probably 1-2 weeks apart. I figure there's little to lose and possibly something to gain? At the very least I wont' have to sit there and watch him scream 4 times - on the other hand, I'll have to take a crying baby home on 2 different days...

Any thoughts on this issue?

Sunday, June 7, 2009

Playing nice

Recently, we've been teaching Melly to be nice.

Some of the kids at her day care were hitting and we were shocked to discover that she was one of the perpetrators. So we took it upon ourselves to train her not to hit.

Me: "Melly, don't hit the babies. The babies are your friends."

Melly: "Fwends."

Me: "So what are you going to do with the babies?"

Melly: "Hit the babies." (Repeat x 100)

But we were eventually successful and now the day care is reporting that she gently pats the other babies and says that they are her "fwends." We have successfully trained our daughter to be nice.

Now it's my turn.

It's not that I'm not nice. I'm nice enough. But when Melly woke me up at 5:30AM and I've just seen 15 back pain patients that morning and now I'm on #16, it's hard to keep a smile plastered on my face. Especially when patient #16 showed up 20 minutes late and now I'm going to have two minutes for lunch.

(I tend to get really irritable when I think I'm going to miss lunch. I hate the fact that it's totally acceptable in our field to have zero lunch break in a day. Sometimes my morning clinic ends later than my afternoon clinic, so I have negative lunch. I guess that means I'm supposed to throw up?)

My new resolution to be nicer comes from a recent visit to my youngish female primary care physician, who was clearly running an hour late and doing my physical exam during a time when most people would be eating lunch. Yet through our visit, she kept the brightest, most cheerful smile on her face. She was so nice, I wanted to hug her. And I'm not such an awesome patient to warrant that kind of niceness.

Obviously, it's great to be a master diagnostician, but I am most impressed with doctors who can exhibit that kind of unconditional, overwhelming niceness. (Especially in a field where there are, let's face it, a lot of assholes.) My PCP is a physician mother as well and I'm sure she has all sorts of stress in her life, but I wouldn't have known it from looking at her. When I look at my PCP, I think to myself, "She is a born doctor."

When I meet a doctor like that, I resolve to walk into every patient's room with a huge smile on my face. It generally lasts for about a day, sometimes less. Sometimes I can only smile through my first patient. Still, I'm working on it. If my two year old daughter can be nice, I can too.

Monday, June 1, 2009

My golden anniversary

When I realized that this was to be my 50th post on this blog, I decided I want to make it good. (Not my usual crap, right?) I asked around for advice and got some suggestions that were good, possibly topics for future posts, but didn't quite have the WOW! factor I wanted. I wanted to make a post that was not just interesting, but.... SHOCKING.

So here goes:

When I joined this blog back in its infancy, one year ago, I had an ulterior motive. The truth was that I felt that going into medicine was a huge mistake for any woman who wanted to become a mother. And I was determined to share that opinion.

Anyone who has read some of my earlier posts would know that I came dangerously close to blurting out that opinion on several occasions, but I always just barely stopped short and ended with some cheesy phrase like, "But it's all worth it." I didn't say what I truly felt because I was scared. I knew this opinion would not be popular. Nobody wants to hear that a woman shouldn't follow her career aspirations just because she wants to have a family. And moreover, I was embarrassed to admit that after seven grueling years of training and 100's of thousands of dollars in tuition, I had major regrets. But I felt that it was important and needed to be said.

(Maybe that's why I've written so much. I'm like the guy who buys twenty unneeded items at the newsstand, hoping the one issue of Playboy goes unnoticed.)

A year later, I still haven't made a definitive post warning mothers-to-be not to go into medicine. But not because I'm chicken anymore; it's because reading these entries over the course of the year has actually changed my mind. Hearing about all these female physicians (both the bloggers and the commenters) who love being mothers in medicine has inspired me. I'm changed. If you guys love it, then I'm optimistic that I can too. Maybe I'm just giddy about graduating residency, but I no longer feel a dire need to tell young female pre-meds to run before it's too late.

So I guess for my 50th post, I'd like to say thanks. Thanks to everyone who posted or commented about how being a physician mama is a gift that only a few of us get to experience. I needed that.

once I get through May (June, July, August...)

It's Monday morning, hope y'all had a great weekend. I did, but the weekends haven't been a problem, relaxing with Husband, Just Five, and Almost Three, as silly and lovable as they all are. Work-wise, though, I've noticed a trend I've fallen into all too often of late. I find I'll have a lot on my plate, usually professionally (sometimes personally) and so I say to myself calmly, if I can just get through May, then I'll have a lot less to do. I'll just get through all these deadlines that have crept up on me for early, mid, and late May, and then I'll be set. But of course, then June rolls around and I have yet more decisions to make, work to get started on, tasks to complete, things to prepare... They are things I enjoy, usually, but a lot of things nonetheless!

Well, when I had my little fender bender last Monday (no one was hurt, kids not in the car) I had an all to harsh reminder that it was time to slow down, literally and figuratively. Might not have been my fault, after all, in an accident you don't intentionally bump into another car, maybe it bumped into you. Who knows? Then, get this, after the accident and exchanging information and seeing that every one's okay, and taking care of all those necessary details, I got back in my car, drove to my morning meeting, walked in a few minutes late apologizing that I had an unexpected delay, and proceeded to lead the meeting for which I'd set the agenda. Only afterwards did I share what had happened with a trusted colleague, and then with my mom (with whom I cried on the phone) and had already called my ever so supportive ("It could happen to any of us") husband.

So, I've decided to slow down, this month, now, today. You?