Wednesday, January 29, 2014

In memory

On January 28, 2014, Dr. Dwight Gustafson passed away in Greenville, SC.

He was the subject of a MiM post several years ago by neurosurgeon gcs15 that brought many of us to tears.

Our thoughts are with his family, his friends, and everyone he touched along the way. If anyone needs any encouragement or inspiration along our path as mothers in medicine, please read that post again.

Tuesday, January 28, 2014

Docs, do you prescribe for your kids?

Genmedmom here. I did a bad, bad thing this weekend.

Both of my kids, Babyboy age 3.5 and Babygirl age 2, have had upper respiratory boogery junkiness for weeks. Both are in some sort of school, hence, they're both sick all the time. We deal with that; it's to be expected. They were either sent home or kept out of school all last week with boogery junky coughs. Saturday: they were pretty good, on the mend, even! Sunday: horrible.

Babyboy woke up very early Sunday morning complaining of a tummyache. Then, ear pain. Then, he started vomiting. He'd hold his right ear, howling and whining, then vomit. He's had ear infections before, and this is his presentation. Prolonged congestion, followed by malaise and tummyache, followed by ear pain and vomiting.

It was kind of scary as he did something I haven't seen him do before- he was grimacing, crying, holding his right ear with one hand, and then hitting the couch with the other hand. Like, hitting the couch with the pain.

Usually, I am a stickler about bringing my own kids to their own doctor to be evaluated for anything. Yes, I am Med/Peds trained, and I passed the Pedi boards, um, ugh, nine years ago.... but no, I do not practice Peds. I hate examining my own kids; I don't have the heart to hold down anyone's head to try to look in their ears.


It was Sunday. It was really, really cold out. Babyboy was absolutely miserable. And it was so, so obvious that he had an ear infection. I knew that if I called his Pedi's office, they would (probably correctly) recommend some sort of eval. On a weekday or Saturday, they are awesome about making same-day appointments happen. But on a Sunday, it's going to mean a ride into the city and a looong wait in a crowded waiting room full of kids sicker than mine.

So, I made a diagnosis. I did examine him, sort of. I listened to his heart, normal. Lungs, clear. I felt his tummy, soft. I tried to look in his ears. He screamed and pulled away. I waited until he dozed off and tried to look in his ears: He screamed and pulled away. He's not that protective of his ears generally, so I figured that was further sign of ear discomfort.

I did talk it over with another doctor, an experienced GP turned oncologist turned internist, who was our own default emergency pediatrician growing up. That would be my dad, still in solo practice after all these years. And, I got a second opinion from a very well-trained internist who happens to work at my same hospital...That would be my brother. And the diagnosis was further confirmed by our informally-trained healthcare provider, my mother, who said something like, "They're been sick for weeks. Get them on some antibiotics already." It was my dad who called in the Amoxicillin, though I figured out the dosing.

Babyboy got some Ibuprofen and Amoxicillin and slept on the couch most of the day... When he woke up around 3 pm, he sat up, rubbed his eyes, hopped down onto the floor and started playing Legos. "Can I have juice?" he asked. Ha.

I felt guilty, though. Was I wrong to diagnose and treat my own kid?

Then, more horrible. Babygirl was a bit off all day. She didn't eat well. She fell asleep pretty early at 6 pm.

Then, around 8 pm, she awoke, screaming. We tried rocking her, tried to soothe her, but she kept screaming this shrill, high scream, kicking her legs in convulsive spurts.

And holding her left ear. Actually she was sticking her finger in her left ear, digging at it, like she was trying to get something out of it. We got Ibuprofen into her and waited for it to kick in. Minutes ticked by and still she was sreaming, convulsively kicking, digging at her ear, screaming, kicking, then "Mama mama mama aaaaaah!" It was pretty awful. I was trying to think what to do. We didn't have any Auralgan... The last time I asked our pediatrician about it, he said he discouraged its use, and told us to use Ibuprofen or Tylenol instead. I thought about... Ciprodex.

Back in the old days, like, when I was a resident, the standard prescription for an ear infection was oral antibiotics plus something like Ciprodex, an antibiotic/ steroid ear drop. Research then showed that the drops didn't do much for otitis media, so the dual prescription fell out of favor. Except with my dad, who had called it in along with the Amoxicillin. So, Hubby ran to get the bottle, and out of sheer desperation, with a sweating, almost crazy with pain Babygirl writhing in my lap, I squirted a good amount of the room-temperature drops into her left ear canal.

She startled, screamed some more, still holding the ear, then, slowly, relaxed. Whimpered, cried out a few more times, then fell alseep.

Hubby and I looked at each other like, Okay? Is that it? I tried to think how the drops might have worked so well, so quickly. I didn't expect the anti-inflammatory effect to take so fast. But perhaps they did nothing more than equalize the pressure in her ear. If the tympanic membrane was bulging out, some warm fluid might have helped ease some of the distension. After all, as my mom pointed out later, an old remedy for an earache used to be warm olive oil poured into the ear canal.

Or maybe the Ibuprofen kicked in. Or maybe she had exhausted herself. At any rate, she had been insanely flailing with pain for almost 20 minutes, and now, was resting quietly. We were so glad. I was almost in tears, actually.

Then we went and pushed our luck. We had two big fresh bottles of Amoxicillin for Babyboy (with alot extra, as the pharmacist had told us to discard the leftover half bottle). We logicked it out: this is also likely an ear infection, let's get her some antibiotics as well. So, I calculated her dose, and tried to slip some into her mouth with a syringe. The first two mls went fine. She sort of gulped and took it.

The last 3 mls didn't go so well. She gagged, and then vomited all over. Ugh.

She fell back asleep and we decided to let well enough alone. She was awake several more times during the night, and we did eventually get both Ibuprofen and antibiotics into her. This morning, she is cheerful.

So both kids are now committed to a full 10-day course of Amoxicillin for ear infections, and neither has seen an actual practicing pediatrician.

So am I a bad, bad mommy? Or will the rest of you 'fess up that you've done the same in similar situations?

Monday, January 27, 2014

an unsolicited job update

The job is going well. Very well , actually. I’ve been in the clinic for over a month, gradually building my own panel of patients and seeing the patients whose oncologist had left during a recent period of high staff turnover. My scheduled was blocked at 50% for the four weeks, which allowed me to learn the different systems and clinic organization without a lot of stress. There are 2-3 people around at all times to answer work flow questions.  I haven’t rotated inpatient or taken weekend or nighttime call yet.  I’ve been seeing mostly women with breast cancer, and although this is not what I was hired to do, I’m actually enjoying it.
It’s funny to think how different this transition has been when compared to that of residency or fellowship, where “orientation” consisted of being handed a massive stack of papers on “code of conduct”, a pager, a list sick patients, and best wishes on finding the bathroom. Before I started in the clinic I had a week of training, where for the first time I actually learned the EMR program I’d been using (far less efficiently) for the last six years.
I like the people I work with. It’s not a perfect group, and still dealing with the aftermath of a difficult period of painful changes, but the other new (ish) hires seem enthusiastic and hard working. The staff that decided to weather the change are less disgruntled than I had anticipated. I’d been warned that my group’s relationship with the hospitalists (very important colleagues when many of your patients require inpatient stays) was unpleasant if not overtly hostile, and this too seems to be improving.
So, I am feeling optimistic. Optimistic that, with time, the move home and into an uncertain work situation is going to prove the right decision.

Tuesday, January 21, 2014

MiM Mail: Burnout (already)?

I am a hospitalist with a 3 year old child and a child on the way and I am burnt out after only four years out of residency.   The prospect of working sickens me and I want to scream when I receive yet another page from the ER about a patient who needs to be admitted with intractable pain/vomiting/weakness with no diagnosis that they could attain.   I am so tired of hearing people's complaints.   I feel like I have not made an ounce of difference in anyone's life.   I am a scut monkey for most physicians and a substitute doctor for their primary care providers.   I no longer get a rush from seeing someone critically ill and helping them become well.  To make matters worse, we are short staffed as many other hospitalist programs are with no candidates thus far.   I am in the process of looking for a job but cannot find one that will pay me not to work.   I wonder on an almost daily basis why I incurred more than $150K of debt to do something that makes me miserable.   I have contemplated switching to a clinic job but cringe at the thought of even longer least in my current position, I am free to come in and leave when I want as long as I finish my work.   The prospect of another hospitalist job is less than appealing and doing chart reviews seems like a surrender.   I have even wondered what things would be like if I had trained in a different specialty.  Would things be different?  Would I be more satisfied with my job?   My husband is a graduate student and thus the option not to work is not realistic at this point.   What can I do?  How do I overcome this overwhelming sense of disappointment and dread for my life's work?  All my life, I wanted to be a doctor and now I'm here and just want to stay home and play with my child.  

Thursday, January 16, 2014

MiM Mail: Radiation risks

Dear MiM,

I am a third year radiology resident and desire to have another child.  I currently have two boys, ages 4 and 2.   My job requires performing fluoroscopy procedures (3-4/day to include HSG's) and I am concerned about trying to conceive while working with radiation.  Its hard to really discuss this topic with the health safety officer as I am only trying to conceive and am not yet pregnant.  This weighs heavily on my mind as I have recently turned the dreaded advanced maternal age.  I have read that its an all or nothing kind of thing within the first two weeks post conception and I am hoping by wearing double lead I am not increasing my risks for miscarriage.  Looking for any advice or guidance as not many women have this issue (=.

Thank you!

Monday, January 13, 2014

A Friendly Reminder to Take What Your 3 year old says with a Grain of Salt

It was a rare perfect morning.

After a rough week, I was actually getting to enjoy my day off. Sipping hot, freshly ground coffee out of my favorite chipped mug, I sat at a tiny table playing legos with the cutest 3 year old in the world. We were both cozy in our jammies relishing the lazy fun play day.

As he began arranging the legos in various piles, we chatted about his plastic construction projects. He declared he was building his house and I gave the appropriate amount of fake enthusiasm over his construction skills. He then handed me a stack instructing me to build "mommy's house."

"But I live at your house, silly head!" I said teasingly.

"No," he said, very seriously, "you live at the hospital, and I live here."

I felt the lump begin to swell in my throat and my eyes begin to sting. Then I took a deep breath.

If this interaction had happened 5 years ago with my first son, it would have driven me to immediate tears. I would have been overwhelmed with mommy guilt and self pity over my hours away.  My schedule would have been reevaluated. Long discussions would be had with me and my girlfriends about how I felt I was failing at motherhood.

Instead of falling apart, I thought a minute and asked my rather creative 3 year old a follow up question,"Where does daddy live?" (Daddy is the 'stay at home parent')

"At the Post Office." He replied quite seriously.

"And brother, where does he live?" I asked with a smile.

"At his school." He replied with a superior tone that nearly had an implied "Duh" at the end.

I smiled, explaining that these are all just places we go, not where we live. He then proceeded to argue with me. I wisely agreed with him because the other thing I've learned over the years is to PICK YOUR BATTLES with a 3 year old.

So the next time your child makes a comment that tears your mommy heart to pieces, it's OK to be sad, but remember to get the whole story. And to most definitely take what a 3 year old says with a grain of salt or perhaps the entire shaker.

Thursday, January 9, 2014

MiM Mail: Overthinking medicine as a career?

I’m in a little bit of a predicament, hoping you can help me with. I’m a college junior, hoping to apply to medical school soon, but kind of at a difficult crossroads.
Let me preface this by saying that I’m 20 years old and I know that it’s maybe too soon to start thinking about children. But, if there’s one thing I know, it’s that I was born to be a mom. I’ll never admit that out loud to my college junior friends, but it’s true. I’ve always loved children, and I’ve always felt that my future kids will have to be my number one priority in my life. However, my mom gave up her dreams to stay at home with my brother and I, and the regret and resentment she feels has really affected our family. I therefore try to overcompensate and promise myself I’ll never radiate that kind of resentment towards my family in the future. But then I think, what if it’s the other way around and I start to regret not having spent enough time with them? I consistently find myself up at 4 a.m. on your blog searching keywords like “balance”, “regret”…you know, really healthy things to be thinking about at 4 a.m. …
I know it’s all kind of presumptuous and maybe silly that I haven’t even stepped foot into a medical school yet (to look around or even interview for that matter), and I’m already worried about these things. But the thing is, medical school is an expensive road to go down, without being 100% in it. I keep reading these terrible horror stories about people who go into medicine and drop out during their third year after having used so many student loans, ect. And for goodness sakes, it seems like every other day some media outlet is coming out with a poll about how 50% or ___% of doctors wouldn’t choose the road again if they could.
I keep going back and forth. Physician or physician assistant. I try to convince myself toward one or the other it seems every other week. I think to myself, “Yeah, I could work on a team. I would still be able to practice medicine.  I could still help people. I think that my time spent with my kids would make up for the feeling of not actually fulfilling my original dream. Or maybe it wasn’t my dream in the first place, maybe I’m just holding onto something I thought about when I was 12. Or maybe I made it my dream so that I would never be the resentful mother.”
Gosh, it’s all so confusing to me. I find myself taking screen-shots of the success stories, or “satisfied” or “happy” mom/doctor submissions on your blog, and printing it out to paste my “study” wall to help me trudge through this MCAT preparation, in attempts to keep me focused and dedicated. Can anyone out there give me insight or share some advice?
An overthinker

Monday, January 6, 2014

Guest post: The two kinds of mothers in medicine

It seems to me, in reading these posts, that mothers in medicine seem to fall into two main groups. First, those that are fully committed to their work, feel no regret about choosing medicine as a career, see working as a positive thing in their lives, and suffer no, or very little, mother guilt. The second group suffer frequently, if not perpetually, from cognitive dissonance between medicine and family.  This group is no less committed as doctors or as mothers, but struggle to marry the two without great dollops of mother guilt. I am in the second group and find myself wondering, as I ride another wave of dissonance, how do I get into the first group?  Clearly there are factors at play which make the elusive balance harder, but even if you allow for those, is there something inherent in my nature, beliefs or values that means I will always have these ups and downs?  What do I have to develop/cultivate/realize to overcome my dissonance and mother guilt to join the ranks of the first group, to which I ache to join?  In theory, I believe that working mothers are a good role model for children, that fathers step into the home more when a woman works which adds more for the children, that mothers make excellent workers and doctors, that workplaces need to support working parents and indeed workers without children to achieve a happy balance but why can't I shake these feelings of conflict? Why can I think my way to balance but can't feel my way? I had a very inadequate home as a child, parenting that raised the interest of child protection agencies. Is this why? Which bits are me and which are over protective parenting making sure my children don't have the pain and loss that I suffered? Would I feel this way no matter what job I did? I think not, because I read so much indecision, conflict and even anguish in the posts on mothersinmedicine. I also read the comments to those posts from mothers in the first group, and I press my nose up to the glass of that group, and yearn to open the door and walk inside. So how do I join you, centered un-conflicted mothers in medicine? Or is that an unattainable dream for me?


Monday, December 30, 2013

MiM Mail: To be a stay-at-home mom or not?

Dear MiM,

I am an OB/GYN in East Texas and mother of 2 boys 9y/o and 3months.  I recently discovered your blog and am delighted to find a place where real women are having real discussions about the challenges of this balancing act. 

My question is have other MiM taken a break while their children where small 2-3 years and then jumped back in?  What challenges did they face?  Any regrets?  In my specialty I fear the "re-entry" - being given a chance by employer and gaining patient trust.  I have worked hard to be where I am and love what I do but given an option to stay home with my children for a few years and I find my heart screaming yes.  Am I over thinking this?


Saturday, December 28, 2013

How motherhood changed my medicine

Better late than never.  Here is my post from topic week on how medicine has changed me...

I've been trying to think of what to write about for this topic week.  How has medicine changed me? I found myself at a loss.  I have been on this journey for SO LONG.  Medicine has grown with me more than changed me.  Then I thought to the one singular occurrence in my life that has changed me the most ... hands down motherhood has palpably and incomprehensibly changed me more than I could have ever imagined.  As a result, after reflecting on how medicine has changed me I really felt compelled to write about how motherhood has changed my medicine.

Here are my thoughts:

- Motherhood has given me an honest compassion that is different than the compassion I had before.  I find it hard to explain, but it is simpler and more organic.

- Motherhood has given me a more zen-like patience with which to approach the craziness and chaos of medicine and residency.

- NICU nurses like moms more than surgery residents ;)  I used this to my advantage and as a result, loved taking care of my NICU babies.

- My priorities have shifted.  My goals are similar, but now they must fit into a different version of me.

- I can't do it all and I know it.  However I will still try.

- I prioritize my time at home and at work with crazy efficiency.  I definitely think the constant balancing act has helped me in being a chief.

- I love sharing my life with my daughter, therefore while at work I am even more motivated to make it count for something, to "help people" as she tells me, to heal, to learn, to affect change.  She has inspired my medicine in ways that make every struggle of motherhood well worth the gain in every aspect of who I am.

Happy New Year.  Here's to motherhood and medicine.

Thursday, December 26, 2013

MiM Mail: Deciding between residency programs

Dear Mothers in Medicine,

I've been an avid follower since the beginning of medical school, and am amazed by the amount of wisdom and advice that passes through. I'm currently a 4th year who is struggling with deciding between residency programs, and was hoping for some much needed advice.

I'm applying for PM&R programs, but applied to a limited area since my husband is a graduate student, and has a few more years of training left in the city where we live now. We met in high school, and had a long distance relationship in college, which was very difficult for both of us. We decided that we would never do that again, and made staying together a priority. We both compromised for medical and graduate school, and went to a city where we could stay together, even though the programs weren't otherwise our top choice. For residency programs, I decided to apply to the surrounding area, because I couldn't stand the idea of being separated.

I'm lucky in that there are a couple of PM&R programs in the city where we live, and a few in a city that's about 2 hours away by car, and an hour away by train. I'm currently struggling with my rank list - I love the programs that are further away, but it would require us moving in between the two cities, and each commuting an hour to 1.5 hours each way, or me taking public transportation, which can take up to 2.5 hours, taking into consideration waiting time for the train and delays. Fortunately I have a friend in the city that I can stay with on the rougher days. Since PM&R has pretty reasonable hours, and I would theoretically study on the train, I'm trying to convince myself that it wouldn't be so bad, but I'm having my doubts.

None of the programs that I've applied to are considered the very top residency programs for PM&R. However, the programs that are further away are better known, and I feel like I would get broader exposure and better teaching from the attendings. My main  question is - how much does the reputation/quality of the program matter in the long run for jobs and fellowships? Obviously there are requirements that have to be met for every residency program, and I've heard from many people that what you put into a program is what you get out. Could I get the same out of a higher quality program as I would out of a lesser known and weaker program, where I put in a lot more effort to self study and seek extra exposures?

Of course it would be easier to stay in the same city, where we have a house and are already settled. But I can't help thinking about the programs that are further away, since they seem like a better fit. I'm afraid that if I decide to commute for the programs that I like better now, the commute might take its toll on both of us, and I would end up regretting it in the end.

I've been agonizing over my rank list for a few weeks now, and still have no idea what to do. Any help would be much appreciated!

Thank you,

Stuck Between Two Cities

Monday, December 23, 2013

Guest post: I do not want to be a vacation parent.

I will preface this blog by saying that I feel very lucky to work at the academic medical centre where I landed right after residency.  I love my clinical work and my education leadership roles. Mostly, I have good support and reasonable bosses. I try to keep all these happy thoughts in mind as we go through the painful process of developing an accountability framework in my large department. Generally, I succeed. I am 100% in support of the major requirements, which boil down to: please do the work you’re paid to do, and provide the people who pay you with some evidence that you’ve been doing that. Sounds good.

At a recent meeting, though, a seemingly minor comment about a seemingly minor clause made me quite upset. In this agreement, a small amount of income will be “at risk” if a departmental member is not deemed to have participated in sufficient departmental activities. Fair enough. However, this requirement includes a certain percentage of rounds held early-ish in the morning (not surgeon-early, but early). The comment made was: “We tried to be sensitive to family needs when planning the timing of these rounds ….  But there are also __ weeks of vacation, of course.”

There was no discussion about this. Introvert that I am, I needed to process this. Weathered faculty member that I am, I knew to shut up while reacting emotionally, until I had time to process my thoughts. They’ve been processed. They’re still emotional. They follow.

I do not want to be a vacation parent.

My husband spends many more awake hours with our 5.5 year old son than I do. As a full-time student, his hours lend themselves to this - he picks the boy up from school and actively parents the kid for a few hours before supper.  I work hard to get home for 6:30 p.m. so we can eat together. I enjoy the 1.5 hours before bedtime where I’m in charge of glockenspiel practice, speaking French (a.k.a “homework”), and then we share bath/bedtime duties. In the morning, I am in charge of the Mandatory Morning Cuddle (there are far worse jobs), and then we have a typical “get everyone out of the door” scramble together. In there, I head off to work just as the boy leaves for the bus.

If you do the math, on weekdays I see my child awake for a grand total of about 2.5 hours daily, at most. When I’m on weekend call, I am at work for about another 4 hours both days, which is minor compared to many, but does mean I miss my share of skating and swimming lessons. Most weekends I work at home for at least a few hours, though I try to do these while he is asleep, but this isn’t always possible. I do not complain about these hours. Compared to many physicians, they’re light. They are what I signed up for, and I believe they are fair.

However, if I add in more morning rounds, I’m incrementally cutting into the time I parent the boy on a daily basis. On days where there are mandatory morning meetings, my son may not see me at all until 6:30 p.m., as I usually need to leave around the time he gets up. These are mostly ad hoc meetings, so I don’t complain (much). Twice weekly rounds start to add up quickly – two days a week of no Mom in the morning.

I do not want to be a vacation parent.

This is really the crux of what bothered me. How is it acceptable to declare “you get lots of vacation time” (for which I am grateful) as a rationale for “parents should have no excuse not to attend these rounds”? At what point is it appropriate to expect parents to not be present in the day-to-day lives of their children, for the sake of non-patient-care activities? I realize that there are many other very valid non-parenting reasons why this might be problematic, but this was a direct comment about parents not wanting to attend rounds at the hours chosen by the Department.

I do not want to be a vacation parent. I want to be present in the day-to-day mundane activities of my son’s life. Believe it or not, I want to be part of the mornings where he is grumpier than a bear, and he has a meltdown because his socks don’t match his jeans. I want to be there to help with the snowsuit battles. I want my mandatory morning cuddle, dammit. I want my son to go to bed at night and know that I will be there in the morning. We worked hard to achieve this balance, and it works for us - well, it works more often than not – what more can we ask for?

It is (almost) irrelevant that I don’t learn well in lecture-based rounds, and that I have to travel more to get to and from these rounds than most in that they are not held at my home hospital. It’s (almost) irrelevant that I participate in teaching activities significantly more than most of my colleagues, so my departmental contributions are considered to be quite high overall.

Clichéd as this might sound – it’s the principle of the thing. Going on vacations with my child is not the same as being there daily. I’m quite sure my kid would forfeit our family vacations in exchange for both his parents being present daily. I would. My bosses may have the right to require me to work different hours, but let’s not pretend that it’s not a problem for families because “there is vacation time”.

So, a portion of my income may well be at risk. Currently, I’ve decided they can keep that if they like. I will cope with the consequences of my dereliction, because I cannot put a price on my Mandatory Morning Cuddle.

I do not want to be a vacation parent.

Thursday, December 19, 2013

On having an au pair

After doing daycare/preschool exclusively for a time (when we only had my daughter), a live-out nanny, and a live-in nanny at various times, we went the au pair route 1 1/2 years ago and couldn't be happier. It's just what our family needs right now. I wish I had known more about it earlier on, since it may have made life easier and richer back then. People may have had different experiences, but here's ours.

We've had two au pairs so far, and both turned out to be great matches for our family. The matching process reminds me a little of residency matching, but without the rank list. You search through au pair profiles, filtering by what's important to your particular family (maybe a strong driver or experience with taking care of multiple children or a particular religion), can read a "personal statement," watch a video they made to tell you more about themselves, scan their letters of recommendation, and their childcare experience. You can select  au pairs to interview (via Skype generally) and have a certain amount of time to render a decision whether you want to match with the au pair. The au pair must accept the match as well, and you agree on an arrival date.  It was a bit unnerving to select our au pairs, not knowing exactly how it would turn out in the end - would she like living with us? Would we like living with her? How would she be with the kids? Like residency matching, you go a lot by feel of a program and projected fit.

What we didn't anticipate was how much our au pairs would be like family to us. They have launched out on their own, excited to see the US - everything is new. You are their host mom and dad, and it does feel a little like that - parental and guiding, showing them the ropes and helping them have a good experience in a new country. Our au pairs have been from Mexico and Brazil; we've learned about their countries. Last year, I made a Mexican Christmas dinner with our au pair at the time N; this year Brazilian.

N was with us for only 6 months. This is not typical. The contract is for a year. However, N's family needed her back home; a family member was ill so she had to break her end of the contract and our au pair company arranged for us to match with someone new. M, from Brazil, has been with us for almost a year. We love her. The kids love her. She loves being here. She's extended her contract for an additional year (the maximum possible) which is great news. There's a ramp up period of about a month when they first arrive for driving lessons, figuring out routines, roles, etc, so having her want to stay longer is a huge plus. Meanwhile, we keep in touch with N who writes me occasionally and updates me on her career and relationships. She's getting married next year and has invited our family to Mexico for it. It's kind of like a mentor/mentee relationship.

In November, M's mom and her mom's friend came to visit, stay with us and travel. They were here for an entire month. This included a trip for the "Brazilians" as my husband and I nicknamed the trio, to Europe for 9 days and a weekend trip to NYC, but otherwise our house was full of warmth and Portuguese  for the remainder. It seems kind of crazy that we had all of these people in our house, but to tell you the truth, it was really nice to have them here. They are such sweet, wonderful people who were the perfect house guests. They made dinner for us all a few nights. We miss them.

An au pair's hours have certain restrictions; they can provide a maximum of 45 hours per week. With our youngest in half-day preschool, this gives us a chance to have a date night each week or coverage on the occasional weekend day I have to work. She picks up the kids from school, drives them to their swim lessons, gets them bathed. We juggle the days and hours when there is an unexpected snow day or sick day. That flexibility has been key. You have to have space for an au pair to have his/her own room and be okay with someone living with you.

I remember one day, during M's first months, she was Skyping with her family in our living room. Her family - her mom, dad, brother, and brother's girlfriend were all there on the screen saying hi to our kids. I looked over at the screen to find all of her family members on the computer screen with their two hands forming the shape of a heart on their chests, and my children mirroring them on our side. I thought:  this is such a good thing.

I drove M's mom and her mom's friend to the airport when they left; I hadn't realized the impression we left on them. They vowed that they would start some traditions back home since they enjoyed them so much while they were here: having wine with dinner each night and listening to classical music. And even though they said their thanks solely in Portuguese, I saw in their eyes what they meant.

We started a tradition last year of including N in our Christmas card photo with the family. This year's card has us all sitting on our local high school bleachers, each of the three kids on our laps - me, my husband and M. This will help us remember the years when our family was a little bit bigger. M cried when she saw the card for the first time, to be included. We couldn't imagine it differently.

Tuesday, December 17, 2013

MiM Mail: Babies and money

Dear MiM,
I have been following this blog since before starting medical school.  It's been so great to be able to draw from your experiences, and to know that it is possible to make family and medicine work (even if it's a little rough).  I am a second year medical student getting married in June. My fiancé is a wonderfully kind, caring person who is more than supportive of my career goals in every way. I'm trying to figure out the whole first kid during training thing and I'm wondering if any of you have advice on how to make it work financially.
My fiancé (F) and I have been under a lot of financial pressure since I went back to medical school, largely due to the loss of my income and the fact that I am currently in repayment for several private loans from undergrad (I could be the poster child for the student loan bubble, and no, they won't let me defer… even though I'm in school).  The thought of having a kid in medical school didn't even occur to me because we can barely afford our dog's vet bills, much less a baby.  Well, lucky us, F got a pretty significant raise, and now we are looking at having a pretty livable income, and the first thing that popped into my head was, "Awesome!  Now we can try to have a baby during M4!"
My concern is this: We are only just getting to the point where we don't hit 0 in the account every month.  F works in fashion production/photography, so while I know he will most likely be able to work from home some of the time, there are days and weeks where his schedule looks worse than an intern's and is probably more unpredictable.  This, of course, means we'll need to work out child care.  Unfortunately we live in Westchester, just outside NYC, so everything is more expensive: rent, car insurance, food, and (I'm assuming) daycare.  We do have family support (his entire family lives near by, including his sister who is a stay at home mom and great with kids) which is great for emergencies, but I feel like we would need to have something in place for the regular day to day. 
For those of you that had kids in med-school/residency, how did you budget?  I know if I wait until residency, childcare will be a lot easier to pay for because we'll have a second income, but I also like the idea of having a little more time with my first born, and being pregnant during what will probably be a comparatively docile year  (especially since I'm thinking I want to do OB GYN).  While all of that sounds great, I don't want to get myself into a situation where I'm not able to do what's best for my child because I didn't adequately plan ahead.

Monday, December 16, 2013

Healthy, nutritious, and delicious to a 2 year old?!?

It is pretty darn hard making food that is healthy and nutritious when you are working 80 hours a week in the Neonatal Intensive Care Unit (NICU) or 50 hours plus commuting in clinic. Add to that the eating preferences of a 2 year old and you have very stressful situations at least several times a week.

Before, I get into what has worked for us, I raise a question to my fellow MiMs and readers: what has worked for you? Please share recipes, links, prayers, spells, themes or anything else you have found useful. 
With the ever rising obesity and dental caries epidemics, O and I are always trying to provide Zo with healthy options. When I have patients in clinic with body mass indexes (BMIs) consistently over the 70th percentiles and disturbing rates of weight gain, and the parents report the child’s favorite foods as “pizza and chicken nuggets,” I cringe. I know it’s hard to get your kid to eat what they need, but it’s worth it, their lives depend on it. And as a doctor, and especially as a Pediatrician, I make it my job to practice what I preach.

Here are a few of our favorites here at the Beehive:
- we prepare what we want to eat (tuna salad, stir fry, slow cooker beans and rice, chicken noodle soup, etc) and then we chop it up, add a bit of cheese, pan fry it on a tortilla and make a toddler-friendly quesadilla that Zo can dip into his favorite Trader-Joe’s garlic-chipotle salsa
- breakfast: greek yogurt with raisins and honey, oatmeal with raisins and molasses, handfuls of raisins (theme = Zo loves raisins)
- lunch: turkey sandwiches with baby spinach, hummus with crackers and grapes
- anytime: hummus by the spoonfuls, oatmeal, Greek yogurt
- when all else fails: his favorite smoothies (said by Zo as a “I want smoo-deeeeee”) option 1 with ripened frozen bananas, a few apple/pear slices, a heaping handful of spinach, milk/ice, and a drizzle of honey or option 2 with ripened frozen bananas, 2 heaping tablespoons of organic peanut butter, milk/ice, ½ cup of raw old-fashioned oatmeal, ½ teaspoon of cinnamon, a splash of vanilla

Hope you enjoy some of our favorites and I look forward to hearing what works for you.