Wednesday, November 21, 2012

Holiday privileges

Here's a question for the ages:

Should employees with children be given preference in terms of not having to work holidays?

I say yes.

And I say this as someone who will be working on Black Friday. And I worked most holidays during residency without complaining. Before I had kids, I actually offered to work holidays so that other people who had family in the area (I didn't) could be with them. After I had kids, I still worked most holidays without complaining.

The only time I ever asked for preference was when I discovered a couple of weeks before the fact that our daycare was closed for two weeks for the Christmas holidays, and there were just a couple of days when my husband couldn't get out of work, and our usual babysitter was out of town. Basically, I had no options, and my program was super nice about accommodating me, so I appreciated that.

I can see how one might argue against this. After all, just because you don't have kids, it doesn't mean you have no family. And while I agree with this, I do have a few arguments for why I think people with kids should get preference:

1) Schools and daycares are likely closed for holidays and nannies go on vacation, so finding childcare becomes a nightmare. I wouldn't want anyone to put their kids in a potentially unsafe situation just so I could have a holiday off.

2) If a person has school-age children, holidays may be the ONLY time the kids can go on a trip to see family members, since you can't pull them out of school.

3) Holidays are important to everyone, but nobody finds holidays as magical as kids, so I think it's worth it to make it special for them. And they actually probably like seeing their relatives.

Maybe if someone has a big family Christmas event every year that means the world to them and it's a thousand miles away so they have to take off several days to go... well, fine. But frankly, I don't think that many adults feel that way. Most probably appreciate having work as an excuse to get out of the Christmas events.

Personally, I don't care as much, since my husband is usually able to take off days when I can't, and my family is very willing to visit me, rather than vice versa. But I know that's not the situation for everyone.

Monday, November 19, 2012

MiM Mail: Ready to quit

Hello to whoever might be reading this,

I am a 2nd year Peds resident in a grueling program, and I have 10 month old baby.  N'er the twain shall meet.  But they did and they are, and that is why I am burnt out.  I am a zombie from sleep deprivation; being on call q 1 is beyond my capabilities.  And my heart isn't in the residency program like it was a few short 11 months ago, but once my son was born all I want to do is be a mom.  I don't think I want to be a doctor anymore, but I can't decipher between not wanting to be a resident anymore vs not wanting to be a doctor anymore. Oh, and I'm 300k in debt. So I can't quit.  But I want to.  I'm away from my son so much sometimes I forget what he feels like. 
I'm hanging on here but the thread is stretching thin.  I envision, mostly when I'm post-call like I am today, walking into the program directors office and saying, "I quit."  It feels good.
Anyone been in this predicament?  Any suggestions? I love this online community and often read it while at work or right before going to bed to check in with all you fabulous other women doing the combo of medicine and parenthood.
Thanks everyone.

Wednesday, November 14, 2012

I Hate the Library

I love to read.

I have ever since I was a kid. Obviously, I don't have as much time to read these days as I used to, but I've read a good number of books this year. I've found if you really like doing something, you can always make time for it.

Back when I was a mother of one, I used to get most of my books from the library. I used to enjoy browsing through the shelves and seeing what appealed to me. Now that I have a toddler, I haven't been able to make time for that, plus I'm terrified of her destroying a library book. So I haven't been to the library in a while.

Last weekend, however, I got bored and decided to take my kids there.

As some of you who read my personal blog know, I have some issues with the library. But since our local library has an entire floor dedicated to kids, I figured that we at least wouldn't get shushed.

When we arrived, my older daughter Mel was thrilled to discover that there was a train set for her to play with (because you don't actually go to the library to look at BOOKS). She started playing with it while I flipped through books with my toddler. I must have turned away for, oh, sixty seconds.... and the entire train set had been dismantled!

Me: "What did you do???"

Mel: "I'm going to rebuild it!"

OK, well, I don't want to stifle her creativity, right? So rebuild away!

Except she wasn't quite done rebuilding by the time she got bored. I think it ended up being more complicated than she thought it would be to fit everything together, and she couldn't do it. She went about ten feet away to the young readers section and started pulling out books.

"I'm going to read these!" she announced.

And of course, my toddler followed her and we all read books together. Yay for encouraging reading!

Except about ten minutes later, a family of three came into the children's area. It was a mom, a dad, and a girl of about three or four. The mom looked at the area where I was sitting with my kids, where we had a few discarded books strewn about (which I was TOTALLY going to pick up when we were done), and says, "Oh my god, what happened here?"

I didn't say anything, just kept reading and focusing on my kids.

Then they go over to the train set, and now the woman is almost screaming, "OH MY GOD, WHAT A MESS! WHAT HAPPENED?!!!"

Then the couple starts discussing what a travesty this is. The dad especially seems really upset that the train set has been dismantled. He actually sits down and starts grumbling to himself while attempting to put it back together. And I hear the mom say loudly to him, "Can you believe this? I'd like to shame her into cleaning it up!"

Now you don't have to believe me, but I was TOTALLY going to make Mel clean it up before we left. I mean, I was still right there. And when I've got two small kids with me all by myself, it's not the easiest thing to not leave a tornado behind you everywhere you go. Even if I wanted to, I couldn't have put that train set back together without both my kids vanishing on me. And to be honest, they didn't even know it was me who made that mess in the first place.

I fully expected them to come up to me eventually and confront me, but apparently, they just wanted to passive aggressively talk about me behind my back. Still, it upset me, so they did their job.

Is it possible for me to bring my kids to the library without some library patron yelling at me and making me feel like never coming back?

Thursday, November 8, 2012

MiM Mail: Taking a year off from medical school for baby

Hi ladies!

I'm a long time reader/ asker and I've got another question for you guys. I'm an M3 with a 2 1/2 year old and am about 5 weeks pregnant with baby number 2.EDD around early July. I had six months off with my first baby and really would have enjoyed having more time. I'm a crunchy kind of mama (attachment parenting, breastfeeding, etc) and I know how I feel when my baby is new and tiny, and I'm certain I'll want lots of time with this baby too.

So, I'm considering taking a year off when the baby gets here, between 3rd and 4th year. I'm not certain I'll ask for it, or even if I'll get it, but I'm wanting to know what I'm getting into if I go down that path. I'm not sure what I want to do, but right now Emergency Medicine and Internal Medicine are my top two, and we live in the south and I have no Ivy League or academia dreams, so no seriously competitive residencies. Preclinical grades are average, Step 1 was above average, but not shockingly awesome. I don't have any research done yet, and honestly, think that the year would provide some time to boost that aspect of my resume (in addition to making connections in EM, since we don't have much exposure there as M3's). I also think I'll be a much, much better intern with a 2 year old than a 1 year old (and I know, because I have been there!) At my school, M4's essentially have 5 months off, but I'd like more time.

So, has anyone done this? Anyone have thoughts on it?

Monday, November 5, 2012

Onion Skinning

I was at a Halloween party at the kids school on Wednesday, opening sticker packets for a craft.  I noticed a few moms I didn't know, so I wandered over to introduce myself.  It came out that I was a pathologist, and later in the party one of the moms pulled me over to talk in confidence.

"I really hate to bug you about work issues when you are on vacation with your kids.  A significant member of my family was recently diagnosed with probable cancer.  She is incredibly healthy, this is a big shock.  My kids don't know about it yet.  She has had a couple of biopsies, and they can't figure out what it is.  Since you are a pathologist, can you review the slides?  Do you think we need to send it for another consult?  She is in another state being worked up.  We feel so helpless and frustrated!  What do suggest we do?"

I was reminded of a case I had a couple of weeks ago.  Walked into CT - a second biopsy was being attempted on a patient with probable pancreatic cancer.  The radiologist was livid that he did not get the diagnosis on the first attempt.  The biopsy the week previous was called "Atypical."  The tumor marker serum levels were sky high and the radiology was practically diagnostic, but they needed our help to call it and start treatment.  I had a heads up in the morning, and had already reviewed the first biopsy, which was looked at by four pathologists.  It was a tough case.

Sometimes the clinician doesn't get at the heart of the patient's problem the first time the patient presents to the office.  Pathology is the same way.  I don't think people realize this - they think it is all black and white.  We absolutely hate to be wishy-washy, and will often gather our colleagues to try to push the call one way or the other - negative or positive.  I was doing a frozen on a laryngeal biopsy on call a couple of weeks ago.  It was scary and ugly but I couldn't go beyond atypical.  Called a colleague to help and he agreed, so I called the surgeon in the OR and gave him the worst kind of answer - "We don't know."  I was thankful the next day - it turned out to be completely reactive/negative.  It is much easier to look at a piece of tissue that is processed overnight than one that is quickly frozen, sliced and stained for a preliminary answer for the surgeon during the operation.

I told the mom the same story I told the radiologist, in an attempt to assuage their respective fear and anger.  "Sometimes it takes time to get there.  When we have definitive specimen, it is easy.  Once I had a case of a patient with probable lung cancer.  It was exceptionally hard to get the diagnosis.  The pulmonologist did two bronchoscopies with washes and biopsies, and despite seeing the mass, they missed it.  The following week the patient went to CT-guided biopsy twice.  Both times the radiologist missed.  I happened to be on frozen sections the next week, when the patient went to open lung biopsy.  It took the surgeon four frozen sections to get to the bottom of it.  I kept calling it negative, and he was frustrated.  'Giz, I'm standing here staring right at it.  Don't tell me you haven't got good specimen.'  He was speaking to me on the intercom in the OR, I was on the phone by the microscope in the gross room staring at the tissue.  He could see the tumor, as did the pulmonologist and radiologist, but he wasn't grabbing tumor, just reaction around it.  He finally got it on the fourth piece of tissue he sent."  That case was an exception - we can usually diagnose the patient more rapidly.  But sometimes it takes time.

I love the term my partner used once to help me.  She calls it "Evolution of Diagnosis."  I was particularly upset about a muddy specimen.  She said, "Gizabeth, our field requires patience.  It's not always clear from the get go.  It's not a failure on our part if we can't call it right away.  Don't internalize it."  In psychiatry they call this onion skinning.  Peeling the layers away to get to the meat, or the psyche.  The diagnosis.  The answer.  Some onions have thicker skins than others.

I reassured the mom that the doctors would most likely get her family member's diagnosis soon, and gave her my name and number if she had any questions.  Assured her that most pathologists are trained well enough to recognize when they are in their comfort zone, which is 95% of the time, and when they need to send something away to an expert.  I also shared that my kids and I recently lost my mother-in-law, their Nana, to cancer.  Told her about the poem my daughter wrote and read at the funeral.  Empathized about how hard it was for kids to experience loss of that magnitude - mine had to at a much younger age than I ever did.  She thanked me and we served orange ice cream punch.  She and her family are in our thoughts.

The radiologist got good pancreas specimen on his second attempt, and I was able to give a definitive diagnosis to the surgeon the next day so they could cancel the open biopsy and the oncologist could start treatment for the patient.  A lot of times our frustrations and anger, as clinicians and family members, are an expression of the emotion that we have surrounding the stress of getting an answer to alleviate the fear of the unknown for a fellow human being or loved one.  When you can step back and see that objectively, it's a lot easier to let go of it all and focus on the job.  Skinning the onion.  Which is not generally a process that can be performed without burning, stinging and tears.  But the answer is usually well worth the effort.

Thursday, November 1, 2012

Guest Post: Five Lessons Learned on Being a Patient

Last summer, I was enjoying a relatively smooth second pregnancy despite my “advanced maternal age.”  It was a warm, sunny Sunday afternoon, closing a (miraculous) full weekend off of clinical shifts.  I lay down to take a little nap; my then-two-year-old daughter climbed into bed next to me. Suddenly – life changed.   I felt a gush of fluid, and knew that I was either bleeding or had broken my water.  To my dismay, it was blood.  A lot of blood.

At that moment, I made the transition that all doctors will make at some point in their life, but which we all fear:  from physician to patient. 

I was now G2P1, EGA 31w2d, with a spontaneous abruption, praying to feel the baby move.   I had no history of trauma, no cocaine use, no history of bleeding disorders.  My husband (who was, luckily, at home) scooped up our daughter and me and drove at what felt like 100mph to the hospital.   I sobbed in fear the whole way.  Thank god, on arrival to the hospital, our little one had a healthy heart rate.  But I was still bleeding, and contracting, and had some cervical dilation.  What followed:  8 long hours of being NPO in fear that I’d need an emergency C-section.  A long discussion with the NICU fellow about prognosis if my little one needed to be delivered that night.  An admission to the labor & delivery floor “just to watch.”  Then a week in the hospital.  Then 2 months on bedrest.   

No one knew why I had spontaneously abrupted, and therefore no one could say if or when the abruption would recur.  Although no large clot had been visualized on my ultrasound, that didn’t mean that my placenta was okay.  I was a nervous wreck, hoping my little one would gestate until he was big enough to avoid the NICU.

Thank goodness, nothing happened over those long 2 months.  I had occasional contractions, occasional spotting, no bright red bleeding.  And 1 week shy of my due date, my son was born, small but healthy.  And I was healthy.  I realize how incredibly lucky I am, and how much tougher things could be.

Still – it was the scariest two months of my life.  And it has changed my way of doctoring.   I walked away from this experience with 5 major lessons for my own practice of doctoring. 

1. Empathize with patients’ and families’ anxiety.

I now understand why people over-interpret their symptoms.  I get why the patient with a history of CABG comes back to the ED every week for twinges of chest pain.  (“What if?.... Last time… I don’t want to be home alone….”)  Often, my primary role as a doctor in the emergency department is to assuage this anxiety, especially if patients have had a long wait prior to being dispo’ed.

2. Be honest about a lack of knowledge, and explain what we can given the limits of our diagnostic/prognostic ability.

I am a physician, and understand medicine!  But I am not an ob/gyn, and have been out of residency for more than a few years.  The only abruption I saw during my training resulted in a stillbirth, so had no practical experience in this diagnosis.  Scarier yet, even among my ob/gyn’s group, management of moderate abruptions differed.  This was scary.  Luckily my personal physician was stellar at making me feel comfortable both with the lack of an evidence base, and with the recommendations she made.

For my patients who are sent home without a diagnosis or clear prognosis, I now try to acknowledge my frustration with this fact, and give an outline of both what I know they do NOT have (e.g. “I am pretty sure your really bad headache isn’t a bleed, or a tumor, but I’m not really sure what’s causing it”) and an outline of when/why they should come back.  I make sure they feel heard, and reassure them, which is often the whole reason they sought medical care in the first place: just to make sure they were okay.

3. Don’t be offended when patients ask for their personal physician when they present to the ED.

In a moment of fear, you want someone you can trust.  I was lucky that my personal ob/gyn was on call the day of my abruption.  I’m not sure how I would have responded to non-evidence-based recommendations had they come from someone other than her.

Now, when patients’ first words on seeing me are: “Have you called my doctor [X] yet?” – I tell them how lucky they are to have such a great doctor as their PCP/cardiologist/whatever, and reassure them that I will work closely with her/him.

4. Give good, thorough discharge instructions.

I left the hospital not understanding exactly what “bedrest” consisted of, and how much I could/could not do, and what would/would not increase my chances of doing well.  I think this was because no one really knows the right answer!  Still, not knowing was very tough for me at first, as I was scared stiff of re-aggravating the abruption.

I now try to be as clear as possible with my patients about what their instructions mean.  (What is “weight bearing as tolerated”?  When can they stop taking Motrin?  At what point should they return to the ED or their PCP?) … .This often involves rewriting or augmenting our computerized discharge instructions, of course.

5a. Acknowledge, and encourage, the use of social supports.

Being sick is scary.  And I wasn’t even physically sick – I was more worried about my fetus!  I can only imagine how difficult life must be for my patients with limited support systems, no money, and fear of losing their job if they stay out of work.  I know how tough it is for people to ask for help, but I encourage them to do so, for their own sake.

5b. Encourage the exploration of online support groups – Especially for chronic conditions, or diseases with little evidence base, the online community is a godsend.  For me, it was my only “good” source of information (although it was also a source of fear, if I didn’t triage sources well).  Heck, think of how important is for all of us!

 Before my abruption, I was already interested in the use of technology to support patient engagement and behavior change.  After two months of bedrest, I became an evangelist for “mhealth”…

Of course, I don’t think that I was non-empathetic at baseline.  I am, honestly, one of those people who always wants to be liked.  But now I try to listen more.  I try to ask what patients are scared of.  I try to reassure more, and to include patients’ families and social supports.  I try to give clearer indications of “if/then” and “what if” scenarios:  e.g. “I don’t think you’re having a stroke, but here are the things to come back for, and here is what I think is going on”.  I now try to explicitly acknowledge patients’ and families’ fear, and encourage my patients to turn that fear to good service:  to use it to increase their engagement with their families, the online patient community, and their own bodies. 

Most of all, I am now actively researching ways to use technology to facilitate patient engagement with their own health.  I don’t want this message to stop with me.

I welcome thoughts, comments, or partnership in so doing!

Emergencymom is an academic emergency physician and public health researcher on the East Coast.  She is proud mother of 2 (aged 4 & 1), and wife of a small-business-owner.  Her work-home balance is precarious, but generally enjoyable.  She still can't believe that she gets to do research for half her work-week!  She welcomes suggestions on how to get 4-year-olds to stop whining, how to have dinner cook itself, and how to not be perenially 1 hour shy of a good night's sleep.

Tuesday, October 30, 2012

MiM Mail: Did you co-sleep?

Hi MiM,

When I had my first son I read a lot and had all sorts of plans for
how it would go and what type of mother I would be.  Co-sleeping did
not fit into that plan.  I knew that the American Academy of
did not recommend co-sleeping and that it may increase the
risk of SIDS.  So into the crib he went.  I didn't intend to co-sleep
with my second son either, but once my sleepless baby boy arrived I
ended up doing whatever worked to get the most sleep.  He naps in his
crib or bassinet but spends a good portion of the night in bed with
me.  I still worry about safety risks and I definitely worry about the
process of breaking this habit at some point.  My question is, as
educated physicians and mothers, how many of you have opted to
co-sleep with your children and for how long?  How do those of you in
pediatrics or family medicine address this with your patients?  I'm
not really looking for advice necessarily, but I think this is an
interesting discussion point.  I found out after talking to other moms
that this is a lot more common than I realized!  This may be somewhat
regional also.  I live near a very liberal, somewhat "hippy" town
where baby-wearing, cloth diapering, and making your own baby food are
often the norm.

I am a PA in dermatology and the mother of 2 boys - 22 months and 5
weeks old.  I love following MiM!


Wednesday, October 24, 2012

Why men earn more than women

Recently I came across an interesting map showing how much women earn for every dollar a man earns. The highlights:

In Utah, the average woman earns 55 cents for every dollar the average man earns.

At best, women earn 3/4 of what men earn.

There are lots of theories as to why women earn so much less than men. Some people say it's because women gravitate toward fields that tend to pay less. But even if you take this into account, women still earn less than men in the exact same job.

The difference does seem to be related to having kids. Apparently, men with children earn about 2% more on average than men without children, whereas women with children earn about 2.5% less than women without children. Women are also more likely to leave the work force for longer periods of time, which further suppresses their earnings.

As a working mom, I really get this. How could I ask for more money when I just took a 12 week maternity leave? How could I ask for more money when I just had to take sick days for a GI bug I caught from my kids? How could I ask for more money when that might make me feel obligated to take on more responsibilities, which I just can't handle right now?

I don't know what the solution is, but I'm sure I'm not the only woman who feels this way. There are probably enough of us to fill at least several binders.

Monday, October 22, 2012

Time for children

Last weekend I was at my friend's baby shower and making small talk with the mother of a baby boy a few months younger than my own son. His mother was a co-worker of my friend, both physical therapists at the local medical center, and the conversation turned to the topic of child care.

I mentioned that I had just worked with an intern who was 38 week pregnant, had planned to take a 4 week maternity leave (she was a prelim and had to start her second program on time), and had a complicated childcare plan in place that involved a sitter coming over to the house around 5 am - when she and her husband (a surgical resident himself) had to leave for the hospital, the sitter would then drop the baby off at daycare when it opened at 8am, pick the child up when daycare closed, and stay with the child until she came home from the hospital around 7 or 8 in the evening.

"Geez", she said, "Maybe she shouldn't be having children. It doesn't sound like she has time for them."

Whoa. Maybe she shouldn't be having children? I should mention that, although I hardly know this intern at all, I like her and I am worried about this plan for what I think are obvious reasons. Children get sick. Patients crash, usually right as you are about to leave. Daycare closes early on Friday for "Teacher In-service" (like every month it seems). Sitters have "things come up". And what about weekends?

My reaction to her situation wasn't that she shouldn't be having children, but that she needed a nanny to get her though a tough few years. I made what I hoped was a polite excuse and left the conversation. 

I was more fortunate than this intern in both the length of my maternity leave and that I had family that could move in with when my daughter was born, but without those two variables my situation wouldn't have appeared that different. I wondered if the same sort of judgement would be passed on me if my early months and years of motherhood were observed by similarly minded outsiders - even now as my mother lived with us for the last two weeks while I was on the inpatient ward rotation. 

I don't feel bad about how I raised my daughter when I was a resident, I feel grateful to my mother and mother-in-law. But I guess we all have different comfort levels for having other people participate in the care and raising of our children. I've had a lot of help with mine and, for the record, I've been pretty happy with the outcome so far. 

Thursday, October 18, 2012

Day 1 of regular exposures

Today I dropped Zo off at his first day of daycare. We finally found a place that we loved with enough diversity so that our little chocolate chip wouldn’t be the only little brown boy in the institution. By word of mouth, we found a quaint cottage-like Spanish immersion preschool run by super cute ladies from Venezuela and Mexico. He loved it during our tour and even attempted to hop out of my arms into the Director’s arms. He was so smitten that I ignored the many dripping noses of the cute 1 year old kiddos who would be in his future class.

This morning I dropped him off around 8:45am. And he was one of the drippy-nosed children. For the last 3 days he has been a sneezing, coughing fussy fuss-face. Top it off with a set of 12 month old immunizations and both parents with sore throats and sneezing and you have entered our purgatory. I have flushed and aspirated his nose so many times that he anticipates what is coming and gets his wail ready. He has woken up so many times in the past few nights that I haven’t been able to lay down for more than 5 minutes without hearing his coughing and whimpering. I can’t wait for this cold to be over so that we can officially begin sleep training him. Add a hectic Ward month with long nights and early mornings and all I can say is that I am so tired. I am so very tired.

As I walked out, painted smile on my face, holding back the tears welling up in my eyes, a cute cherubic girl smiled at me and motioned for me to hold her hand. The Director hurriedly waved to one of the teachers so that she could wipe away the thick yellow-green goo running from her nose, sliding down her face. The teacher laughed nervously, I shrugged knowingly. I have been around enough children to know clear, yellow, and green ooze is somewhat of a rite of passage. Thus began Day 1 of our son exposing others to his germs and his classmates exposing him to theirs. Here’s to a robust immune system! Here’s to my growing Little Man!

Monday, October 15, 2012

MiM Mail: Dealing with a chronic illness

Hello MiM blogosphere-

I'm a surgical resident, wife, and mother.  I love planning, writing lists, checking boxes, and emailing my husband with "action items" -- basically, the 21st-century Honey-Do list. 

Despite all of that, I have found myself in a situation that I never planned for. 

Recently, I was diagnosed with a chronic illness.  Without getting too specific, it will impact how I do my job, but won't prevent me from doing it.  Think of something along the lines of Crohn's disease, Type 1 DM, or lupus.  I have to take medication, monitor my symptoms, and go to doctors appointments.  I might have to take a 5 minute break during cases that last more than 6 hours.  But, my doctors and I see no reason why I cannot continue to provide excellent care to patients.  I'm lucky that there is even an attending surgeon at my institution who has the same chronic illness that I do.

All that said, finding out this news has been Really Hard.  It's scary, and overwhelming, and my head is spinning.

I worry about where my disease will take me... What complications are in store?  How will I handle it on those days when I feel really bad?  Why isn't there a cure for this thing, yet?  But, what I'm worrying about most are the practical protections, financial expenses, keeping insurance, dealing with a chronic illness and surgical residency (a chronic condition in and of itself!).

So, I appeal to you all with three big questions.  Maybe you've been through something like this before?  Or seen someone go through it? 

1.  What and how do I tell my co-residents?  My attendings?  My program is hard and the hours are very long (80 hour workweek, what??), but it's actually not all that malignant.  I know my coresidents and attendings will prioritize my health and giving me 10 minutes of self-care time during a 15-hour workday probably won't be a big deal... But, what I really worry about is the loss of opportunities.  Like, if one of my attendings wants a resident to help with a cool research project, but they don't ask me, reasoning that the extra work will be too burdensome with my illness.  Same thing if a good case comes in late in the evening...what if they don't ask me to stay because of my illness?  Will all the credibility I've built up as a hard-working, excellent resident slowly be eroded by missed opportunities? 

2.  How do I handle this with future employers, when I apply to fellowships and ultimately attending jobs?  Am I obligated to disclose this information?  My field is fairly in-demand (at least right now), and I'm a good resident at an excellent program, but is chronic illness a big enough 'black mark' to mar even an otherwise exemplary CV?  I'm terrified that if I'm not the best-of-the-best--if I'm just average--my illness will make it such that employers pass me over for someone who is totally healthy.

3.  How can my husband and I protect ourselves financially from the risks of my chronic illness?  He works full-time in a well-paying field... though his salary is about half of what my eventual attending salary will be... assuming I don't scale back to a slower-paced practice given my situation.  We always assumed my career would be the primary one... we'd move to follow my job prospects, I'd have the Cadillac disability insurance, he might even eventually work part-time or stay home entirely to focus on parenting.  It seems like all of that is changing, and I'm struggling to figure out how we should reprioritize.

Kind of a heavy post, I know... but I certainly appreciate any insights.


Tuesday, October 9, 2012

Sick Day

I wake up at 4AM feeling nauseous.

I'm not that surprised. My girls have been vomiting all weekend. Not just vomiting, epic vomits. Like the kind where they vomit a lot and you think, "Wow." Then they vomit again. And then a third time. And now it's on the couch, the carpet, the TV, basically everywhere in a 50 foot radius. And then just when you think this may never end, they burst into tears, because vomiting makes kids cry.

And they want a hug. But they're freaking covered in vomit. I mean, you have to hug them, of course, but you have to at least attempt to strip off some of those vomit-soaked clothes first.

I get this horrible sense of foreboding, but I somehow manage to fall back into a restless sleep and wake up later with my alarm. I still feel really nauseous and my stomach kind of hurts. But I get up and force myself to take a shower.

The living room still sort of smells like vomit. I swear, we cleaned it. I went to the drug store and asked the clerk what would get out baby vomit from the carpet and I got a bottle of Woolite. But I don't know, maybe there's a patch of vomit somewhere that we missed. Probably there is. There was just so much of it.

If anything could have made me feel less like eating breakfast, it's walking into a living room that smells like vomit. Thank God both kids are already awake. I feel like if I have to argue with anyone or do anything unexpected today, I will break down.

The daycare serves breakfast till 8AM, and I think I'm going to make it. We arrive and as I bring my littlest into the toddler room, I see a bunch of one-year-olds sitting around the table with little bowls of food. But I don't see the food cart. "Can she still get breakfast?" I ask.

"Sorry, you're too late," they tell me. It's 8:01AM.

"Is it possible for her to get any food at all?" I beg. "She didn't want to eat before we left." And keep in mind, if you tell me "no," I may vomit on you.

They seat her at the table and say they're going to try to scrounge up some food. If they're deceiving me, I don't even care anymore.

I drive to work. I'm really nauseous now. I wonder if I could throw up. I don't feel like vomiting is imminent. Like I don't think I'm going to have to pull over and yak all over the road. If I'm not actively vomiting, I'm well enough to work. Period.

In the hospital, I make a beeline for the bathroom. My stomach is cramping and I feel like I'm in labor with a vomit-baby. I lean over the toilet but nothing comes right away. It's generally easier to birth a vomit-baby than an actual baby, but it's just not coming. Someone knocks on the door, which totally disturbs my concentration. I can't vomit with someone standing right outside the door!!

I go upstairs and pick up my patient list. It isn't too long. Maybe I can get through it fast. Hopefully nobody will talk to me.

I go to the bathroom. Vomit success!!! But it's not that much. Maybe my symptoms are all psychosomatic, because I watched both my kids throwing up.

No, I should probably just call in sick. The world won't come to an end. It's not fair to anyone for me to be working in this condition.

I leave the bathroom and just stand there, debating what I should do. My boss walks by and I call his name. "Hey," I say.

"Hey," he says. "What's up?"

"Um," I say. "My girls have been throwing up all weekend and I just threw up. So... I guess I should probably go home."

"Yeah, that's fine," he says. "Feel better."

"Here's my patient list," I say, trying to hand it to him.

"I'm not touching that," he says, recoiling in horror. "I'll get a fresh copy."

Fair enough.

I drive home. Maybe I'm not that sick. Maybe I should have just stayed and worked. But then I could have given this awful bug to everyone I work with. I mean, it benefits the hospital if they don't have half the staff out with a stomach flu. I'm sure they'd rather lose me for a day than have that happen.

At home, I try to vomit in the toilet. I can't. Maybe I should have had a bigger dinner last night. How can I be home if I'm not actively vomiting?? Now everyone is going to think I'm an unreliable mom. My husband comes into the bathroom while I'm sitting on the floor by the toilet. "Maybe I should have worked today," I say.

"I can't tell if you're teasing me or if you're really insane," he says.

Little of both, probably.

Sunday, October 7, 2012

Stressed Out

My Life has been a roller coaster for the last couple of months.  I don't mean a nice Disney coaster either, I'm talking about Cedar Point 120 mph craziness.  Two partners have taken maternity leave this year and I have done my best to work extra and be supportive, but I think this year is taking its toll on me.

I feel like I have always kept a a decent work life balance. I exercise, eat well, make time for my family and attempt to take some time for myself in general, but over the last 6 months that balance has been close to impossible.

The additional roller coaster involved being offered  the opportunity of a life time this summer.  I was scheduled to travel internationally for 3 weeks. All expenses paid. Patients were rescheduled, passports obtained and childcare was arranged. I was SOOOO excited. Then the day before departure, the trip was canceled.

{Insert sad trombone}

So, back to work I went.  In hindsight I should have taken some time off, when I already had it blocked, but alas, I'm a glutton for punishment.

Somewhere during these crazy few months I started having these crazy fantasies: what if I had to have emergency surgery?  Wouldn't that  be AWESOME.  I could take a week off to recover. No one could bother me.  Now, before those of you who know me IRL have me admitted to the psych ward, I in no way ever wanted to hurt myself. Or have anything really wrong with me. No crying spells, no anxiety attacks. I just keep dreaming of  having an unruptured ectopic. Serious enough for surgery and a week off, but not life threatening or overly painful.

We go back to fully being staffed next week, and I have scheduled myself some down time to re-energize. I  have been focusing on that and already feel much better.  Hopeful to be back to my peppy self soon.

Anyone else ever get so busy and stressed out that they start imagining how awesome it would be to have appendicitis? 

Friday, October 5, 2012

Guest Post: Pregnancy, Delivery, Postpartum as the Patient

I am a small town girl from the middle of nowhere that recently graduated from OB residency in the big city and I am currently doing an MFM fellowship. I am also now 3 weeks postpartum with my first child. Whoa…what an experience.

I thought I knew everything there was to know about pregnancy, delivery and postpartum issues. Let me just say….life from the table side of the stirrups is a whole new world.

Pregnancy was a whirlwind, with the exception of 5 weeks of nearly continuous nausea and terrible heartburn, I loved being pregnant. I, like many pregnant women, had this perfect plan for how I wanted my delivery experience to be: spontaneous labor, short second stage, no episiotomy, no operative delivery, 7 pound baby.

Well…I was long/closed/posterior and floating at 39+ weeks and I got a primary elective c-section for macrosomia. Baby boy ended up being 8’14 and he is perfect. I have no regrets. C-section recovery wasn’t so bad…the first 36 hours were rough, but otherwise pretty smooth sailing. Baby boy nurses like a champ…although I referred to him as “baby T-rex” for the first 2 weeks. Seriously…the sore nipples are no joke.

So now I am staring down the barrel of the end of my maternity leave. I have always loved my job. Everyday I felt like I did something good. Every baby that I deliver is an amazing experience. If you have to wake up at 2am…why not deliver a baby and change someone’s life forever. I thought my life would never be complete without it. Now I consider leaving my fellowship on a nearly daily basis.  I can’t imagine leaving baby boy for 10-12 hours a day.

I chose to do a fellowship for the potential for a better lifestyle as my children get older and because I truly love “maternal medicine.” But these days I think maybe I should just leave fellowship and moonlight a few shifts a month. At least where I live, I could moonlight 4-5 nights a month and make the same money I make a fellow.

Will I ever love my job the way I used to again? Or will I look at the clock all day and just want to be home? Will I regret it if I quit? Can one really do it all…be a good fellow and a good Mommy? My poor husband doesn’t know what to say to make it better. I have never been a crier…but several times since having the baby he has found me rocking the baby in the nursery with tears streaming down my face. I can’t help but think that by going back to work I will miss all these sweet moments.


Tuesday, October 2, 2012

Cure for what ails ya

Hi, MiM folks. Long time no see.

I have a lot going on. I am a few months into my internship. I am applying for obstetrics residency again. I just submitted four abstracts to two conferences, I just presented at one conference and will be a presenter at another, and there is a lot going on, women's health wise, in politics and in the news.

So what am I so worked up about that I am going to break my blogging fast?

Facebook medical advice.


I joined Facebook when I got accepted to medical school. My incoming class started a Facebook group and used it for introductions and announcements. I'd never used MySpace. I started off Facebook with a bang, since our class had almost 250 members in it, many of whom were young whippersnappers used to this social media stuff. Now, of course, I'm a pro, and have been recently accused of being a "Facebook slut" because I have so many "friends." They come from many, many different walks of life. Definitely not all medical people, and not all mainstream.

So, one of my non medical friends (someone I know from an online mothering support group from years back) posted about some symptoms she found troubling. She was suddenly very dizzy - the room was spinning, and her vision and balance were off. Not really nauseous, no other significant symptoms, and I know she doesn't have a significant medical history and she said she wasn't on any medications. She said - anyone have any idea what could be causing this?

"Hmm, sounds like vestibular neuritis," I thought. I posted "Most likely vestibular neuritis - sorry :(" I purposely said "most likely" because hey, who knows, and I didn't want to sound like a know it all. I threw in the frowny face to seem more friendly and less know it all-y, too.

I wasn't so perturbed by the people posting guesses about low blood sugar or low blood pressure, even though those are technically more likely to cause lightheadedness than dizziness. I know that distinction can be difficult even for a trained medical professional. Or a patient describing symptoms, for that matter.

But, then there were some more productive suggestions:

"Go to the ER immediately and ask for a blood test, which will most likely show it is dietary affecting your blood preasure(sic)".
"I felt really bad recently and it turns out it was food poisoning. I poo'd and I felt better!"
"Intestinal parasites can cause this!"

I made a snarky follow up comment about how it was definitely sporns and she should drink some OJ. I didn't mention that I was a doctor and would you people just! listen! and stop making dumb suggestions for non existent blood tests or very unlikely etiologies. Especially since I had twice, nicely, suggested a likely cause that they could have googled. Maybe that would have been better than the sporns comment, I don't know.

I knew I wasn't fit for further commenting when someone posted how it was "Vertigo. OR an inner ear infection" and I wanted to write in all caps "VERTIGO IS A SYMPTOM, NOT A DIAGNOSIS! SO, NOT "OR"!! AND INNER EAR INFECTION WITH VERTIGO = VESTIBULAR NEURITIS!!"

When did I become such an insufferable know it all?


I should just go take a poo, and I bet I would feel better.