Sunday, January 2, 2011

Great Expectations

"I always wanted to build model planes," he said, wistfully examining the partially finished one on the table. "My father would not allow it. He collected stamps, so we collected stamps." - King George VI in The King's Speech.

Of all the dialogue in this outstanding movie we saw on New Year's Eve, this gave me sudden pause.

It is not, after all, too surprising that much might be expected of a king's child. Great privilege is accompanied by great expectations. How difficult it must be to live such a life, especially in the age of ubiquitous media. I feel a certain pity for Kate Middleton, whose life can certainly never be normal again. I actually wept in the theater for King George VI and his terrible predicament.

What a compelling depiction this was of the effect a tyrannical parent can have on a child. Ultimately, George V admitted the respect he had for his second son - too little, too late.

Throughout history, a certain personality type has been attracted to a throne. Genghis Khan, Elizabeth I, Julius Caesar... none of these was a gentle or shy type. I believe many surgeons share this same super-Type A personality. I recognize it in myself. Without some such traits, it is difficult to get through training and be successful in this field.

Rulers must not show weakness; they must appear confident at all times. They must relish control and enjoy making decisions that affect the lives of real people. So it is with surgeons (and some other specialists) as well. The OR is very like a small kingdom in many ways.

It can be difficult sometimes to moderate those personality traits at home with family. Clearly being so Type A has its advantages, but there can be a dark destructiveness to it. King George VI evidently knew that well.

I can understand his father, George V. As a successful monarch, he must have wanted his children to be just like him. Anything less would imply failure on his part to produce equally successful offspring. He must have felt the need to control his children's development as he controlled everything else. When he could not correct their flaws, he felt disappointed, frustrated, even betrayed. He could not countenance failure.

I admit that I have felt shades of this. I suspect I'm not the only one. Like many surgeons, I have always been successful at most things; I have never really had to face a major failure. I have generally been able to make things happen the way I want them to. Raising a child, however, is different.

My son is the most precious thing in my life. My greatest wish is for him to ultimately be happy and successful. I know he is not me; I don't really want him to be. He is a different person, and that's a wonderful thing. I would never push him into a field he didn't love - yes, including medicine. Nothing could change my love for him.

Nonetheless, I have found my Type A side struggling at times. Two things have bothered me the most.

He is not a straight A student. He has the ability, but he just is not motivated to accomplish this. I tell myself that he is just 12 and that B's and C's are OK. He may buckle down as he matures. We make sure he gets his work done, and we try to help him study for tests, but he's just not interested. He would much rather play hockey or watch ESPN. This is so frustrating to me... and I can't understand it. At a visceral level, I can't imagine not having the drive to be top of the class.

Worse, he hates to read. Loathes it! Even before he was born, I dreamed of reading together with him. I imagined sharing the books I have loved all my life, laughing and crying with him over the pages. I know now this will never happen. It may sound silly, but this is possibly the biggest disappointment I have ever known. But I can't change him, make him love something he doesn't.

None of this sits well with the controlling part of me. At times, I'm tempted to yell my frustration at him, force a book into his hands, take away his sports. Obviously, I tell myself, that wouldn't be fair, and it would only make him resent me. Type A or not, I don't want to be King George V, dictating what my son will and will not enjoy, will and will not do.

I've been mulling over the reasons that scene moved me so. I think it had something to do with recognition, and with fear.

Kings or physicians, our children are the most important part of us. We want so much to see the best of ourselves in them. We work so hard in part to give them the best opportunities to build a satisfying life for themselves. We know only one route to success and happiness, the one we have walked ourselves. We fear that their differences from us may spell difficulty for them, or even failure. Where they fail, we feel that we have failed.

Further, we crave a lasting bond with our children, one that will connect us through the years and the inevitable separations. Subconsciously or consciously, we try to cultivate similar tastes and interests, ways to understand each other better. The love comes naturally; the mutual understanding is harder. We fear loss and loneliness.

My biggest challenge may be letting my son grow into a different person without trying too hard to interfere. I can't change my surgeon's Type A-ness, and I can't change him. Nor can I change my hopes for his future. Perhaps my New Year's resolution should be to interest myself more in the things he naturally enjoys instead of yearning to make him over in my own image. I should focus less on my own disappointments and more on the joy of who he is. Truly, there is so much to be joyful about.

Since the time of Dickens and before, parents have had Great Expectations for their children. Let us have the wisdom to recognize our own fears and shortcomings, and to temper those expectations with purely unselfish love.

Friday, December 31, 2010

The Rescue

When my divorce was finalized in September, four days after I moved into a new house, my 7-year-old daughter Cecelia started bugging me for a new pet.

We already have a 2-year-old Florida king snake, Spotty Dangerous a.k.a. Cosmic Creepers. I am now a single mom. I dreaded introducing a new member, another being to take care of and mouth to feed, into our household.

“Cecelia, if you make your bed every morning and get your homework done on time, get good grades and generally maintain a positive attitude, we’ll see about getting a new pet at Christmas.”

My declaration has haunted me over the past few months. C took my words to heart, and kept up her chores daily. Her bed making skills became exemplary. She dutifully handed over every penny she accumulated in allowance in eager anticipation of a new household member. She became addicted to pet rescue websites, poring over the animal bios searching for the perfect pet.

I have never been a cat person, but I was so worried about the responsibility of walking and caring for a dog that I steered her in the feline direction. They seemed a lot easier to care for. Cecelia discovered a shelter in a town about an hour from our city – it houses over a hundred stray cats, and her daily forays to the website became obsessive, at the very least. I wondered, reading each cat bio, how the workers could possibly nail each cat’s personality into a three sentence summary – they must be manufactured for the consumer.

A couple of weekends ago, true to my word, we headed for Hot Springs to the cat shelter. I took the kids to the local pet store the day before and we loaded up on kitty litter, scratching pads, and cat toys. The last cat I had growing up, Puff, was somewhat brain damaged, I think, and ultimately ended up dying of starvation after getting stuck on a neighbor’s roof. One of my roommate’s cats in college used to bang on my door screeching while I was trying to sleep after an all night shift at the home I worked at for people with schizophrenia. I wasn’t very optimistic. The last thing I wanted was to have a cat sleep in my bed, so I researched the compatibility of cats and snakes on the Internet the week before.

“Cats and snakes are incompatible. They should be kept in separate rooms. Under no circumstances should they be left alone together.”

This was good news for me, so I harnessed my little brother, home for the holidays, into building a fancy aquarium (terrarium) stand with me for Spotty Dangerous to take up permanent housing in my room, therefore wiping out any possibility of the cat spending the night in my room.

As we entered the shelter through a thrift store in front, I wondered what we were getting into. Cecelia summed up the atmosphere in one sentence, “Yup, this must be a cat shelter – I can smell it.” Strangely, when we were thankfully escorted back to the cat shelter after being told it was closed due to lack of volunteers, the smell dissipated – it must have belonged to the items in the thrift store. The shelter was surprisingly clean. We received a brief orientation.

“You can go into each room and play with the cats. You are not allowed to go into the medical ward. The special needs ward is off limits to the public. We’ll start you off in the teenage room. We don’t have kittens, currently.”

We squeezed in through a door that numerous cats tried to exit the moment it was opened. It was a clean room with concrete floors full of scratch pads, litter boxes, and about thirty teenage cats. My five-year old son Jack was temporarily threatened by the ones that jumped on him and clawed through his pants, but the volunteer worker quickly handed him a fishing pole feather cat toy that distracted the cats from him. He laughed maniacally as numerous cats jostled for the feathers. Cecelia wandered around intently focused on finding the perfect cat. I noticed one in the corner of the room lounging apathetically on a scratch pad, neglecting the excitement that Jack was providing for the majority of the cats in the room. Eventually Cecelia made her way over to the cat I was eyeing.

“Look, Mom! Look at this one. She is so sweet. And her name is Caitlyn!”

We came to the shelter with their favorite babysitter, Caitlin. So this discovery was particularly exciting. Of course we had seen Caitlyn on the shelter website, and she had our interest piqued – she was mostly black and it seems that black cats are usually not adopted due to traditional superstitions.

“Mom, this is the one. Caitlyn. Let’s call her Katie.”

We took Katie home, and quickly changed her name to Katybell, at the suggestion of my brother. “It’s more of a cat name.”

Lo and behold, Katybell is just who we needed. She is more like a dog than a cat – following every household member around and snuggling and cuddling every chance she gets. One morning not long after we adopted her, at about 2 a.m., my daughter Cecelia snuck into my room, filled with anxiety.

“Mom, I can’t sleep. She just wants to play. I’m so exhausted.”

“It’s ok, C. Just put her in the laundry room.”

A couple of minutes later I heard Cecelia crying in her room. I wandered in to see what was wrong, crawled into her bed, and held her. “Are you OK?”

“Mom, she’s crying. She needs me, but I’m so tired. I can’t handle it.”

Lord, I had so much empathy for her. I remembered when she and Jack were babies mewling quietly in their rooms and I was trying to catch some sleep before a busy day of residency. Since I had just been with them an hour or so before I told myself that they were all right, not urgently in need of anything, and fitfully tried to catch a couple of hours of sleep. I consoled her.

“It’s all right, C. She knows you love her, and she will be OK in the morning. Your sleep is just as important to her well being as it is to you. Stop worrying and try to get some rest.”

Cecelia finally dozed off, and I wandered back into my room to sleep. True to my word, Katybell held nothing against us when we let her out of the laundry room in the morning. She has become a permanent fixture in our household, after only a couple of weeks. She is an amazingly laid back kitty, indulging Jack in carrying her around the house like a sack of potatoes and pleasing both kids in long morning games and charades over the Christmas holidays. The TV might as well go out the window. She loves us, and we love her. So much so, it makes me look into her soulful questioning green eyes and wonder who rescued who.

Thursday, December 30, 2010

Reverse sexism

I try not to post twice in a row, but this conversation amused me too much:

Husband: "Would you support me if I decided to go to medical school to become a surgeon?"

Me: "Yes, absolutely."

Husband: "Really?"

Me: "Yes, because it would be hilarious."

Husband: "You know, I might do it just to prove a point to you."

Me: "I'd love to see how far you'd take that joke. You haven't even taken any pre-med courses."

Husband: "I took a term of biology in college."

Me: "That's not quite enough. You have to take a year of biology, a year of chemistry, a year of organic chemistry, and a year of physics."

Husband: "Well, I've got the math requirement down."

Me: "There's no math requirement."

Husband: "Oh. Well, are any of those courses actually required? Aren't they just recommended?"

Me: "No."

Husband: "Mel, do you think Daddy should become a doctor?"

Melly: "No."

Me: "Why not?"

Melly: "Because boys can't be doctors!"

Monday, December 27, 2010

Saving eggs

Recently when I was stuck waiting for a doctor's appointment, I started reading a magazine article about IVF and I was fascinated. The article talked about IVF isn't an experimental treatment anymore, and how women in their thirties are storing eggs for a time when their lives are more amenable to childbearing. And how you can even store a slice of your ovary for future access to hundreds of eggs.

Of course, I couldn't help but think of how this might apply to women in medicine. I'm sure there are tons of women who shy away from competitive fields like surgery because they don't want to spend their prime childbearing years in rigorous training. Egg storage sort of evens out the playing field between men and women, but I don't think it's very mainstream right now... I don't know of any women who have done it. I remember on Sex and the City, Miranda gets heckled by her date when she brings up the idea of storing eggs. (Although that was admittedly a decade ago and also, I don't even watch that stupid show, much less have seen each episode multiple times.)

Personally, for a risk-adverse person such as myself, I don't think if I could do it. The article said that for a woman under 35, harvesting eight eggs only gives you a 50/50 shot at pregnancy. Plus there are hormones involved, which scares me a bit. Then again, I never wanted to be a surgeon and really had no compelling reason to delay having kids.

The other issue is the cost. I have a friend whose wife is (unfortunately, unsuccessfully) going through IVF right now, and he's informed me that the cost of IVF has trumped all the daycare costs I'd been complaining about. Insurance doesn't generally cover IVF, but there are arguments why it should. Women implant more embryos when they know then only have one or two shots at success due to cost.... this results in multiple pregnancies, which ultimately results in higher medical costs.

Before I say anything (else) that will surely be construed as judgmental (smiley face), I'll throw the question out there:

Would you consider saving your eggs for the purpose of use in the future?

Sunday, December 26, 2010

Laughter is the Best Medicine

No one wants to be in the hospital at Christmas.

Well, maybe some people do, especially if they're lonely. Certainly everyone whose deductible starts over again in January seems to. But despite the urgency patients feel to have elective surgery over the holidays, I sense that none of them is really happy about it. Neither am I, for that matter. I hate that December is always my busiest month (71 cases this time around).

So, every December, there is generally an undercurrent of "Bah, humbug!" lurking in the hospital hallways, sort of like the invisible coating of drug-resistant bacteria on the ICU surfaces. This never helps me percolate any kind of holiday spirit.

Early this month, I stopped at the drugstore to pick up some toiletries. Next to the shampoo section, my eye caught a display of silly over-the-top antler headgear festooned with blinking Christmas lights. I found myself grinning a little and thinking what my son would say if I picked him up from school wearing a set of those antlers. So I bought a set out of mischief - what are parents for if not embarrassing their preadolescent kids?!

On the way home, wearing those blinking antlers, I realized I was still grinning - and I came up with a very un-Grinch-like idea.

The next day, I arrived in preop holding wearing my white coat... and my antlers. The staff gaped, then giggled. I went to see my first patient and watched the anxiety on her face melt into laughter. She rolled back to the OR still smiling. And so it went, all day long. It was the most fun I'd had on a workday in December since - who knows?

The OR staff enjoyed it so much that on my next OR day, several of them brought in Christmas headdresses of various types: elf ears, Santa hats, snowflake crowns. I myself bought enough headgear that I wore a different set every operating day through the 23rd. My inpatients looked forward to seeing what would come next; one actually wanted to stay an extra day just to see what my head would look like. Every patient seemed a little brighter than usual this month (a lot like my head!).

I have always thought that humor is a key to communicating with patients and making them feel at ease. I use it whenever I can. My Christmas headgear experience has made me realize how big a difference it can really make, not just in the patients, but in us as physicians, too. A laugh can dispel the shadows of fear in a patient's mind; they're all afraid, each in their own way. We, too, are afraid - of the things we can't control, of the grimness of disease and death. Just as the Hogwarts students could dispel creatures resembling their greatest fears with humor ("Riddikulus!"), so do we have the power to help our patients and ourselves grapple with the dread of illness.

I wish we all could recognize this. Interesting, some of the comments I heard from my colleagues when they saw my festive antlers. Twice: "I don't know if I'd have the confidence to have someone wearing those operate on my brain!" "Do you really let your patients see you in those?!" Most telling: "I bet not many neurosurgeons would be seen wearing those..."

No, sadly, probably not. Ours is notoriously such a dignified, serious profession. The classic image of a neurosurgeon is a tall, graying man in a suit and tie with a grave expression who can burst into a tirade at the drop of a hat. No smiles, no fun, and certainly no antlers for him! After all, the patients and the world must hold him in the utmost regard! I have always secretly been pleased to look (and to be) nothing like that classic stereotype. Our field needs more laughter... and more humanity.

That's the comment (from a chaplain) that struck me most: "I am glad to see you wearing that. It lets the patients see that you are human."

Indeed. I couldn't agree more. If I learned anything from my Christmas antler experiment, it is that many physicians still take themselves too seriously. We have an important job, no question. But if we are to give our patients the best care, we must find ways to connect with them on a human level. We need to pay less attention to our dignity and more to empathy, all year round. A little laughter, sometimes directed at ourselves, would go a long way in all our relationships.

In this season, we celebrate the Incarnation, the perfect divine coming to share the imperfect human experience. What a good time to put the physician "God complex" behind us and show our patients that we, too, can listen, can cry, and ... yes, can laugh.

Thursday, December 23, 2010

Guest post: O, Christmas Tree

 Last night, I hosted my book club because it was easier for the others to come to me, the emergency doctor on mat leave with a 3.5-week-old baby girl, than it was for me to travel.

         One woman pointed to our Christmas tree and said, "Your tree reminds me of a task we use in therapy:  take two Christmas ornaments out and put them on the floor.  Don't put them on the tree.  Just let them sit there.  See how long you can last.  It's for perfectionists, you know?"

         My four-year-old son had done most of the decorating while I frantically cooked French toast for dinner (using homemade bread I made with my own hands, after my husband forgot to buy bread!).  This meant the tinsel was looped mostly around the bottom of the tree, he'd smashed one glass ball, and all the Christmas lights were plugged in to various sockets, some of them blaring different Christmas tunes, all of them flickering enough to potentially trigger an epileptic fit.

         I cleaned up the glass, grabbed the French toast before it burned, and muted the Christmas lights before I got marooned nursing on the couch while my husband left to put our son to bed.  So yeah, my tree might make Martha Stewart cry.  And yes, the first book club member to arrive helped wash my dishes.  But I've got pretty good work-life balance.  Here are my tips.

1.  I married a laid-back guy 
It does drive me nuts that he'd rather have sex and play World of Warcraft than just about anything else.  But on the upside, we're both on parental leave and getting a bit of sleep instead of going berserk.  That'll come later, when he goes back to work in a few months.  He does most of the laundry, nearly all the grocery shopping, and has taken over the school lunches.  Yay.

2.  Save your money so that doesn't dictate your life
My parents raised me to save like Scrooge ever since I can remember.  Now our house is paid off and our expenses are relatively cheap.  It's important for me to dictate the length of my own mat leave, so after the Ontario Medical Association (me) and Employment Insurance (him) are tapped out, my corporation will pay me what I need until I go back to work.  I know saving money is a laughable concept while you're in school, but when the money starts coming in, remember that paying off your debts means financial freedom, which as far as I'm concerned, equals just plain freedom.

3.  Get a cleaner
I'm with RH+ on this one.  I felt guilty at first, but now, I think it's a good idea to pay someone who does a much better job instead of constantly singing, "Clean up, clean up..." to my family and then end up doing all the tidying up myself anyway.  I don't feel as alone trying to fight the tide of toys, dirty dishes, etc. and it frees me up to do other things only I can do, like write or nurse my baby.

Of course my work-life balance isn't perfect.  I cut back on my shifts during my pregnancy because I wasn't functioning well afterward.  By that, I mean that I almost caused a car accident on the way home on one shift.  This did not go over well during a doctor shortage and I know there will be payback when I return to work.  Plus, well, you already have an idea what my house looks like in between cleaning bouts:  broken glass takes priority, not artistry.  But for the most part, I am happy, which is more than a lot of people can say.  Now I'm going to have a nap, which will make me even more balanced.  Cheers.

Tuesday, December 21, 2010

The Neverending Commute

In every marriage, there are sacrifices. And in marriages where both partners work, there are often geographical sacrifices.

I've made sacrifices. When I was getting ready to apply for residency, my husband got into a graduate school far away from my family and friends, in a fairly competitive location. Because of this, I had no choice but to apply to internal medicine residencies to maximize my chances of matching and getting to live with him, which was the most important thing to me. When I was in med school, I loved neurology and PM&R, but there were only 6 PM&R spots in the entire area and 8 neurology spots (4 of which were at a "malignant" program). And prelim spots were impossible to come by. So I made a sacrifice and applied for medicine instead.

Amazingly, it all worked out okay in the end though.

Then when we were job hunting, I chose the general quadrant of the country where I wanted to live, and my husband job hunted first. Once he found a job, I looked within the same city for mine. It limited my choices, but I found something.

Now his sacrifices:

I hate to drive and I suck at it. I have been in four car accidents, one of which was a serious one requiring a hospitalization, so while I'm willing to have a long public transportation commute, I don't want a long drive. My husband's job is 30 miles away from mine in the Middle of NoWhere (MONW). My job is a bit in the middle of nowhere, but less so in that there is public transportation here, which allows easy access for us to get into the city and for visitors (such as our parents, who don't have cars) to visit us. So we live in the city where I work, and in exchange, I chauffeur our daughter to and from her daycare (also in the same city).

This has become a source of guilt for me though. Usually his commute is 45 minutes to an hour. But on bad days, especially now that the weather has taken a turn for the worse, his commute home has gone up from an hour to an hour and a half.... and it has twice taken him TWO HOURS to get home.

When he gets home from such a long drive, he is not a happy camper. He generally just wants to lie down and not talk to anyone, and usually says a few four letter words about the highway. And of course, I feel totally responsible and very guilty. I did look for a job near his work, but the economy sucks. It's amazing that I found a job that I like in the same general area and that pays well (more than his).

All this is further complicated by the fact that he is considering going back to school on his company's dime. All the grad schools are closer to where I work, but that won't happen for a year and a half at soonest.

I don't know what to do. I constantly feel guilty about this. I've scoured google maps but any place we moved that would shave ten minutes off his commute would add thirty minutes to mine. It doesn't make sense, especially since my days are longer than his and it takes me at least 30-40 minutes to do the childcare stuff in the morning.

Sometimes I feel like the only solution is to quit and stay home.

Sunday, December 19, 2010

Welcome to Work-Life Balance Topic Week

It's another Topic Week at Mothers in Medicine, and this topic is near and dear to all of our hearts: work-life balance. Throughout the week, we'll be featuring posts dedicated to this topic. Thanks for joining us this week and being part of this community.

Scroll down below to find the posts...

Ten guidelines for medicine-life balance

Right now, this month, seven years out of residency with a part-time position at the refugee clinic and three and three-quarters children, I have work-life balance. It's somewhat precarious, something that could be toppled by illness or an unbearable colleague or a newborn, but I would rate my current satisfaction with both career and home life as high. Here are some philosophical and practical guidelines that I follow:

1. Accept that you can't have it all - at least not at once - but you can have a life that is rich and full and satisfying. I watch resignedly as other (childless) physicians at my clinic leave to spend months working in Afghanistan and Peru. I'm the mother that arrives late to the preschool Christmas potluck and sets a box of mandarin oranges next to the homemade cheesy noodle casseroles. My son's school uniform pants are embarrassingly short and I couldn't make a recent cross-cultural mental health conference because I'm home with my daughter on Thursdays. But I have kind, secure children and what is arguably the most delightful, rewarding patient population in the city. It's enough.

2. Be clear about your boundaries and don't apologize for them. I work Mondays, Tuesdays and Fridays. I can't start any earlier than 9AM due to school drop-off. I've had potential employers rework schedules and change clinic start times when I tell them my availability.

3. Don't compare your finances to others'. Recently, my six-year-old son asked me, "Where do you and Daddy get money from?" He was taken aback when I explained that we are paid for our work. All this time he had assumed we were going to work for pleasure and to help others. This pleased me no end. I don't want money to be the prime consideration in my decisions.

Every year the BC Ministry of Health puts out the "Blue Book", which lists what every physician in the province billed the Medical Services Plan. I've perused it before, but no good comes from seeing that my family physician neighbour bills more than five times what I do. I start to gauge the wrong things in terms of money; what are quiet days at home puttering in the yard with my four-year-old worth?

4. Say no. This may be the most important skill I've learned in the last five years. If I feel awkward saying no to someone's face, I say I'll consider their request. Then I say no by email. I don't bother with reasons or excuses. I came across a quote from one of Dr. Gabor Mate's books a few months ago that I think of almost daily: "Always choose guilt over resentment."

5. Write. I take ten minutes once or twice a week to document for myself what was memorable. This has a magical way of allowing what's important to rise to the top while the irritations of daily life drift away, affording perspective. Here's something lifted directly from a journal entry this summer:
Playland yesterday, Leif smiling as he soared through the air, Saskia looking non-plussed even when having a great time. It felt wonderful to give them a day of whatever they wanted, unlimited rides, mini-donuts, cotton candy, a snowie despite wasps hovering over the syrup spigots, eaten cross-legged on concrete in makeshift shade. They were good as gold. Felt strange to see legs dangling from a great height, delighted screams, ferris wheel buckets the colours of candy against the North Shore mountains, and think that the same world has refugee camps.
6. Consider exhaustion the state of having given, rather than having been taken from. A few months ago, as I rounded the bend to approach the Second Narrows Bridge on my way home from work, CBC's Rich Terfry on the radio and Ariana strapped in the backseat, I thought with dismay how overwhelmingly fatigued I was. I felt drained, spent, exhausted - and reflecting on these words I realized that resenting others having taken from me was passive and inaccurate. I had given what I had by my own choice. When considering Dr. William Osler's words, "Let each day's work absorb your entire energy and satisfy your widest ambition," anything short of collapsing into bed completely spent each night feels a waste.

7. Travel lightly. I try to apply minimalism to every aspect of my life. People remark on how tidy my home is, but the truth is that we have very little stuff. I decided two years ago to leave the HIV clinic to focus my part-time work at the refugee clinic only. We eat simply. Any commitments are carefully selected and for a defined period of time.

8. Hold an AGM with your spouse. Once a year, Pete and I hire a babysitter and take an evening to take stock of where we're at in every major area of our life: his work, my work, finances, church, where we live, parenting, friendships. We identify what's working, what needs to change and when we need to reevaluate. We like to feel that our choices are deliberate; we don't want to float up to our forties to say, "Huh! So this is how we live." I have such fond memories of these evenings, full of gratitude and brainstorming and collaboration, and everything recorded in my notebook.

9. Three projects. At any given time, I have three projects on the go that require one to two weeks to complete. One relates to work, one to home and one to something creative. For example, I might apply for a research grant, order a coffee table and frame some of my photos for our front entry. No new projects can be tackled until all of the original three are completed. (See zenhabits for more.)

10. Marry well. Pete (who works full-time in a non-medical field) is supportive, a non-complainer, hands-on with the kids and flexible around gender roles. We've both made sacrifices. He is undoubtedly the linchpin to my current contented state of mother-doctor.

I've loved William Wordsworth's poem "Nuns Fret Not at Their Convent's Narrow Room" since I studied it in English 103, particularly these lines:
In truth the prison, unto which we doom
Ourselves, no prison is.
I'm a mother in medicine by choice. I accept any challenges and restrictions inherent to this position, for this is exactly where I wish to be.

Saturday, December 18, 2010

The work*life product and other insights

We've been talking about work-life balance this week in the context of motherhood, but clearly this is a concern for anyone in medicine. Partly, I think this comes from the personalities that are generally attracted to/selected by the field, leaning towards the driven and perfectionistic (and at times, a-retentive), as well as the demands of caring for patients: hard to turn off, hand off, or leave at the door. For me, though, motherhood really made this concept all the more relevant, as suddenly the "Life" part of the equation got significantly more complex. Having to stay late at work takes on a whole new meaning when that means you might miss a meal or a bedtime of someone who is "your heart walking around outside of your body."

These past 5 1/2 years of motherhood and living work-life balance have given me some early insights:

Work-life balance is highly personal. Set your own standards.

We were on vacation over the summer at the beach for one week. During the week, I had a monthly work-related conference call for a national committee I serve on. I decided beforehand that I would see how the week was going (the call was near the end of our week away), and that I'd call in for it if I felt like it. Well, I felt like it. After spending 24/7, all-family, all-the-time, (including an 8-9 hour car ride involving listening to 2 hours+ of straight crying), I was ready for a brief break away, if only by phone. Yet, calling in and admitting that I was on family vacation at the beach and might not stay on for the whole call made me suddenly self-conscious, much like I feel self-conscious about sending colleagues manuscript drafts on Friday nights (I have). I wondered what they were thinking and whether my "balance" was questionable.

But, I have come I'm coming to accept the fact that I draw so much satisfaction, meaning, and identity from my work. I would be miserable not working at all and taking care of the kids full time. I would likely be miserable working only part time. Doing meaningful, satisfying work makes me happier when I am home, more patient, a better mother than I would be otherwise. And, I'm telling myself that it doesn't matter what others think, as long as I am happy with the way things are going, that my family is happy with the way things are going. Really, that's what matters, not someone else's standards. (And who cares what others think?)
There's no ideal "mix" or balance that fits everyone. Finding your own "groove," is key.

"Work-life balance" is a less helpful concept for me than "work-life product"

When I think about balance, I think about a see-saw, with work sitting on one side of the fulcrum and life on the other. That seems to denote that to be in balance means to have similar weighting to each side, in similar quantities. Yet, in real life, I feel that these weights are always in flux and being in a state of mental/emotional harmony depends on the work*life product to be under a certain threshold (much like the calcium-phos product). For instance, it would be okay if family needs became temporarily higher when work needs were low, or if a flurry of work demands occurred during times of quiet on the home front. But, when both of those demands become high for whatever reason, that's when things get untenable. Hopefully those times are only temporary, resulting in only a minor amount of pesky metastatic calcification (e.g. my nanny nightmare + temporary work insanity = sad me), but when they are sustained, then changes have to be made.

Your workplace "terroir" can greatly affect/encourage/stifle your sense of balance

In wine-making references, the term terroir refers to the sum effects of a local environment (the specific geography, climate, soil, farming techniques, etc) that results in the final product. At work, the organizational culture surrounding work-life issues-- managers, your boss, colleagues, inherent flexiblity of your job-- all contribute to your sense of balance. When I first started working at my job, I didn't feel it was very supportive to me as a new mother. When I announced my pregnancy, the first response was "how long will you be gone? 6 weeks?" (In my ideal world. it would have been, "Congratulations! *hug* How can I help you?") I was the only mother of my group and worked with many men who gave me a hard time for missing conferences due to pumping--I felt like a criminal trying to get out at a reasonable hour to see my child before her early bedtime. Yet, now, things have changed. Those men have left (hooray!), I've negotiated for more protected time (hooray!), and now, I have a supervisory role that allows me to create a environment that emphasizes the importance of work-life. Small gains like instituting policy and precedent for my section to take "in-lieu" days off for having to work a holiday hopefully will add up to an overall supportive culture. Finding a work environment that meshes with your own ideal of work-life balance can't be underestimated, and if not, work to change it if you can, either from within or finding a new job (like dr whoo courageously did).

Re-evaluate, re-evaluate, re-evaluate

As with any process, it helps to periodically re-evaluate to make sure things are going smoothly from everyone's perspectives. I remember one time when my husband mentioned (jokingly) something about how we both just tended to get absorbed in doing work side-by side on our laptops after the kids went to bed each night. It was totally true, and a reality check. It's so easy (for me) to get sucked into (bad) habits and not stop to reflect, or step away and see the big picture. I need to be reminded to take that time to re-evaluate and to check in with everyone.

Best of luck to all MiMs out there, finding your own work-life groove and defending it. And periodically checking in with all stakeholders (yourself, your partner, your children) to make sure nothing needs tweaking. And definitely keeping that work*life product to non-toxic levels.

Friday, December 17, 2010

It was the best of times, it was the worst of times...

For me to write a post about this particular topic, that is. This is my second week of finals and in keeping with tradition, it has been a little more interesting than usual in our household. Monday night, the boys were at scouts and I had recently tucked KayTar into bed and subsequently settled in to study organic chemistry when I heard a very familiar sound...The Prelude to Vomit in F major. I sprinted to the kitchen for a bowl and then up the stairs, but I was seconds too late. She had already thrown up. I held out the bowl and caught the rest and when I looked down I was shocked to see a couple of teaspoons worth of bright red blood mixed in with her bedtime feed. Once we got everything cleaned up, I emailed our pediatrician and asked her opinion and gave her our best guess as to what happened (nosebleed that was draining posteriorly into her stomach) and she agree we could watch her for a while, but if it happened again, we'd need to go to the EC. Watchful waiting is always a little unnerving, but it is taken to another level when you know you have a final the next morning! I emailed my professor so she would be aware of the situation, in case that is how the evening played out. Thankfully, it all worked out okay, she didn't vomit again and I made it to my final, but I did have to flake on an important organic chemistry study session to be close by in case we had to run to the hospital. It doesn't always work out so nicely, though, in my Spring term, KayTar had emergency surgery during finals week. Our house was burglarized last Tuesday, the day before my music final. Finals week paints a cosmic bulls-eye on our household, but we have survived it yet again.

Before I decided to go back to school full force, pursuing a career in medicine, I talked to several physician/mothers that I respect a great deal. Balance was always a central theme in these discussions. What I learned in talking to them is that it is definitely possible to be both a good physician and a good mother, balance is possible, but it is not always an easy thing to find that balance and balance rarely means the same thing to two people. It is more complicated than usual for our family, because KayTar has special medical needs and my husband works full time and is a full time student, too. For us, these things have been key.

1. Determine YOUR priorities, re-evaluate as necessary.
My highest priorities this semester included: Never miss organic chemistry. Go to all of KayTar's medical appointments/hospital visits. Be present and active in the kids' school life. Spend time in clinic. We had several rough spots in the semester, but I never missed organic or one of KayTar's appointments, and I made sure to volunteer in the kids' library as often as possible. I also spent several days shadowing. Your priorities are probably totally different than mine, but just recognizing what they are makes it easier to stick to it.

2. Compromise where you can.
I did stick to all of my priority items, but I had to compromise in other areas to do so. I missed history and music on more than one occasion to go to one of KayTar's appointments. I missed several of my son's baseball games because I was in the hospital with KayTar.We skipped KayTar's dance class at least once, because I needed to study. Last night when I was working through 228 pages of organic chemistry and KayTar kept bouncing back into my bedroom like a ping pong ball, I finally scooped her into my lap and said, "I know you reeeeeally want to play with me right now, but I'm studying for my very last test right now and it is very important. After tomorrow, I'm all your for a month!" She understood and went on her way. You can't always do it all, but you can make time for a little bit of everything.

3. Our family is a TEAM.
The only way any of this works is that we are all committed to it. Laundry is usually falls under my purview and dishes belong to Josh, but if I'm drowning in orgo, he'll put on a couple of loads for me....if he's writing papers and the sink is overflowing, I'll load the dishwasher for him. I usually pick up the kids, but if I'm in clinic, Josh handles pick-up. Josh cooks dinner, but if he's busy cramming for an exam, I'll cook get some take out for us. If one of us needs a hand, the other always helps out. Extended family is part of the team, too, and without their support (especially my mom watching the kids when they get sick and have to miss school), we couldn't make this work.

4. Take time for yourself/family/friends.
I've found that I get a lot more accomplished if I take periodic breaks and do something relaxing, than if I try to power through and do more, ignoring myself altogether. If I'm having an especially intense study session, I'll give myself 30 minutes of free time as a reward every time I finish a section. The kids understand that mom and dad have homework just like they do and for the most part, they let us work and study when we need to. When I'm drowning in coursework and need a break, I'll ask BubTar to play Wii with me or I go have a tea party with KayTar. Sometimes a little time together is all we need. We don't have a lot of time for dates or social events with friends, but when the stars align, we jump at the chance! Everything seems easier after a great date night or evening spent with good friends.

I'm sure there are other important factors, but for us, these are the biggies. As an undergrad, I know that this is probably the easiest my life will ever be...medical school, residency, and practice will take more time and effort than school currently does. Sometimes I think I must be clinically insane to be pursuing this, but I love medicine and I'm committed to making this work. I hope that as time passes and we enter into the next stages of this process, we will continue to find a way to make it all work.

When Balance is Lost

What a time for a "Work-Life Balance" topic - just as I begin picking up the pieces of my life again. I thought I was doing a great job of juggling everything, and even (finally!) finding time to build some friendships - something I previously viewed as too much of a luxury to maintain.

And then, not one, but two of my family members were diagnosed with serious illnesses within a few days of each other. When Husband was initially diagnosed, I remember thinking "Wait a minute - this is the kind of thing that people read about and think Thank God that's not us" - except it WAS us, and I wasn't reading about it, but living it. And suddenly, my carefully constructed house of cards was crashing down around my ears. Scrambling to find coverage so that I could be at his side for two surgeries (one to remove a cancerous tumor, one absolutely unexpected correction of a bizarre bleeding complication) within 10 days strained not only my extended family, but my work relationships. As he was recovering and we had received the fabulous news from his surgeon that the margins were clear and no chemo or radiation therapy would be required, I dared to breathe a sigh of relief.

Barely done exhaling, the next day I received a call from my mother (yeah, I wish I was making up this timing) who lives several hours away. "Can I send you a report from a test I had done?" The report described a biopsy of an intra-abdominal mass lesion, which based on the sample received, appeared highly malignant and possibly metastatic. Um, WHAT? When did this start? You've had symptoms for how long? Back onto the patient-advocate wagon I climbed, this time trying to keep track of everything from hundreds of miles away. And now, several weeks later, Mom is beginning to recover from her surgery, with a follow-up appointment with a radiation oncologist still pending.

So what did I learn from this about balance? For one, that it was remarkably easy to jettison areas of my life that I thought were "musts". A phone call here, a brief (or not so brief) explanation there, and I was able to rearrange paperwork, lectures to residents and even days of patients. The "extra" things outside of work that I used for relaxation and ways to build friendships - gone with the blink of an eye and the click of a "send" button heralding an explanatory email. Will I restart these? Absolutely - at some point in the future. Because although it was easy to dump them now, I know I'll eventually miss doing them - and ultimately, these "extras" are part of what I use for balance.

But for now, I'm focused on making sure that the pieces of my life that I hold dearest are intact before I start juggling again.

Thursday, December 16, 2010

An exercise in work life balance

I can’t get no… exercise. That’s what went. It left me sometime around the second trimester, about 7 years ago. Previously near daily jogger and once even a marathon. I have the rest of the balance, most days, between what I do at work and what I do at home with daughter, son, and my life partner. As an outpatient pediatrician I only rarely have weekend or evening obligations such as taking phone call, but as an academician I am working for fun (ha!) from home during the late (after the kids go to bed late) evenings because I’m often productive at that time. And then it “frees up” more time during the work day to 1) drop off my kids at a reasonable hour, 2) pick up my kids at a reasonable hour, and 3) interact with other people at work.

But back to the exercise, that is what I gave up, and I am feeling off balance about it. When I read my MIM peers who carved out that time, I am jealous, but the other thing I can’t do is get up early to do it. Love my sleep in the morning, right up until and including those little snugglers who, well snuggle in with us most mornings. I can stay up late at night, too late, easily, but other than using our brand new Wii, I don’t have exercise equipment at home to use in the wee hours. I think for my next big birthday I’ll get a treadmill for our basement. Or maybe Wii bowling will do the trick. Doubt it though. A recent development, while both kids are in non mommy-and-me swim classes I do get to use the workout machine, overlooking the pool at the Y, so that's once a week. Not enough, but have to start somewhere.

Got to get you into my life, exercise.

How to be a resident with a baby (and not lose your mind)

Having a baby during residency is a scary thought. Residency is scary in itself and adding a whole person you're responsible for into the mix makes it even scarier. But I survived it without losing my mind. Here are some tips:

1) Be in a cushy residency.
It's easy to act like a big hero juggling a residency and a baby when you're in a residency that's probably less work than most attending physician jobs. I can't imagine a better residency to have a baby in than my PM&R residency. I took call from home, worked only a handful of weekends each year, and even had several rotations with built in mornings or afternoons free. Sure, it would have been nice to work parttime or not take call at all. But for a resident, I think I had an easier time obtaining the work-home balance than most.

2) Have a husband who's Awesome.
Well, we all have husbands who are awesome, right? My husband was a student when my daughter was an infant and he was able to stay home with her a lot, which was great bonding time for the two of them. My mother is still amused by the delicate care and knowledge with which he prepared her bottles. I can't say it was a perfect situation though, because childcare sometimes got in the way of his studies. Our situation is different now in that he has a full time job, and I'm curious to see how it will affect his relationship with our next child. (He's really close with our daughter.)

3) Have a nanny who used to be a cleaning woman.
When I came home from work every day, the dishes and laundry were done and the house was spotless. That helped a lot.

4) Learn to type with baby balanced on chest.
Probably my first several work presentations were composed in such a way. Very efficient.

So I guess in summary I don't really have any super secret Jedi tricks in order to survive being a resident with a baby. I survived mostly through a combination of luck and making the easiest choices.

Wednesday, December 15, 2010

MiM Mailbag: Resident mom barely keeping head above water

When I heard about the latest topic week on work-life balance, I became excited to participate and finally submit a post. I've been a long-time reader and often refer new mamas in medicine to the site. I’ve spoken at a Resident Physician Parenting Workshop for the last two years and was a member of a recent Task Force that authored a document called Medicine and Motherhood: Can We Talk? I'm a mother to a joyful (but sleep depriving) 2-year-old, spouse to a wonderful MD/PhD student, and very happy to be finishing a family medicine residency here in Canada shortly. I thought I could write something witty, something useful, or share some secret for success… but all I can do is shout out for HELP!!!

I'm looking for help because, well, this teetering balancing act of physician, mother, spouse, friend, and committee member is about to fall apart!

I've cut back on committees and extracurriculars and even did a career switch (internal medicine to family medicine) in attempt to regain some equilibrium. I have in-laws that are happy to help, use money from my line of credit to have cleaners every other week, and have a fabulous daycare. And yet, I'm still barely keeping my head above water.

Hubby and I barely see each other -- this month I'm working nights in Emerg and he's on 1:4 call for the general surgery service. I think we spent less than 8 hours awake in each other’s company this week.
I never seem to have time to study or read around cases. Hubby feels like he's barely prepared for days in the OR and for exams. I feel like I could be a better doctor if only there was more time or energy.
And this beautiful child, well, he doesn't like to sleep much. And although my brain screams "No Way!", my heart is ready for another baby (or two).

How do you other MiM make it work? Everyone else seems to do it "better" than us -- they study more, are more well prepared in the OR, their dinners are home-made, and their kids are sleeping longer.
Said only very slightly tongue-in-cheek...