Wednesday, December 31, 2008
In the year 2009, I will have been graduated from high school for 16 years, graduated from college for 12 years, graduated from medical school for 8 years, married for 8 years, and a mother for 5 years, and graduated from residency for 4 years. I can't believe it. I turned around, I blinked, and the time was gone. I read once that as we get older, one year of life statistically becomes shorter. For example, at 2 years old, 1 year is half of your life, at 50, I year is 1/50 of your life. I do know that the coming year holds a big move, hopefully a sale of a house, the start of a new job (and with it a new lifestyle), kindergarten for CindyLou, and a multitude of other wonderful things that I couldn't even imagine. And it will feel like just a minute ago, but 2009 will be over, as well. My father always says that "These days *are* the good old days." I know one day I will look back at myself at 33 and laugh at how "young" I sounded. So my resolution for 2009 is to take each moment, the stressful and the relaxing, the harried and the hopeful, the highs and the lows, and remember that it is but the most fleeting moment in time, and from that, may I, may we all, find peace in truly living each moment in the coming new year. Happy New Year, Mothers in Medicine!
Saturday, December 27, 2008
Thursday, December 25, 2008
The wintertime, especially around the holidays, is a really depressing time for residents. Especially interns. There's nothing like being on call during the holidays, driving to work while it's still dark and knowing you'll be up all night and won't be going home till the next day. That you'll be away from your family, your spouse, your child on a holiday that's all about togetherness. It's a time when a lot of sleep-deprived interns are pushed to their breaking point.
So if you're someone who works in a hospital as a doctor, nurse, or professional patient, do something nice for one of those depressed residents stuck in the hospital through the holidays. A few kind words, a cookie, a much-needed hug, etc... it's all good!
Wednesday, December 24, 2008
One of the patients I met that week was a woman I'll call Sara, a nonsmoker in her 40s with lung cancer and carcinomatous meningitis. She was getting intrathecal chemotherapy instilled into the Ommaya reservoir in her brain three times a week...and this week, while her attending was skiing in Colorado, it was my turn to do it.
As you can imagine, putting chemo into someone's brain is a tad unnerving. The sterile field is no joke. Enough said.
Sara was a delightful young woman but very scared of needles. Sara's husband was an extraordinarily hairy, extraordinarily affectionate guy. Though I had never met them before, it was obvious they were MADLY in love. They had been married for 7 years, as they told me in a giddy voice at some point, but they looked like honeymooners--nuzzling noses, rubbing each other's shoulders. It bordered on inappropriate for a clinic waiting area, but I figured: hey, she's got metastatic cancer; they can do whatever they want. I certainly wasn't going to say anything about all the physicality....
except that it was almost impossible to administer her intrathecal chemotherapy. Over and over, I would sit her up and prep and drape her upper half. At the moment of truth, dose measured, name and history number of the sticker double-checked against her hospital bracelet, syringe full of chemotherapy approaching, his big hairy hands would grip her cheeks through the drape, and he would plant a big kiss on her forehead and say, "It's just one more small needle, hon, and it'll be over in a few seconds" or "I love you so much. You are the strongest woman I know." On more than one occasion, he actually lifted the drape with those big furry hands and said, "Baby, how do you manage to look so beautiful without a single hair on your head?" He looked lovestruck every single time I saw him, as though he would die if she had to be draped and therefore out of his sight for another minute. Over and over, I explained that this was the brain we were dealing with. Over and over, I explained the sterile field and how you really couldn't get in it, seriously. Over and over, he couldn't resist--or, more precisely, couldn't resist her. Every single time I saw her that week--three visits in all--it took at least 3 tries to seal the deal and instill the chemotherapy into her brain. Though I will admit that it drove me crazy at the time, particularly on the busiest days, I always walked away from those visits kind of smiling to myself.
I learned 2 or 3 weeks later from Sara's attending that she had passed away. She was sitting on the toilet one morning and just fell over dead. Her husband was so grief-stricken by the realization that she was gone that he just held her on the bathroom floor until she was cold and it was dark outside, and then called 911. By the time the ambulance came, she was clearly long-deceased, and they did nothing more than give her (and him...in the back, lying on the stretcher with her) a ride to the hospital. Apparently it violated their policies, but apparently they couldn't say no to him. Huh.
Though I didn't know either Sara or her husband well, I was absolutely overwhelmed by their love. I have cared for a lot of cancer patients and their families at the end of life and witnessed love under the magnifying glass of impending death more times than I can remember. But Sara and her husband were different somehow. Their love was truly unconditional, timeless...raw and unstoppable.
I'm not sure why, since I really didn't know him, but I decided to write him a quick condolence card. It was a completely nondescript card from a box of generic condolence cards--a sad reality of life as a medical oncologist that we buy the bulk condolence cards in packs of 10 or 25 the way others buy their generic thank you cards--but it's the thought that counts, right? As I wrote and reflected on why I had been driven to write to this near-stranger, the words just kept coming. It ended up having 2 or 3 extra pages (all on basic white paper from a Staples 500 pack) added, folded up inside the card. Unleashed, the letter morphed out of my control--as I recall, there was talk of great loves and young life inexplicably cut short and spirituality. I never got any reply. I hadn't really expected to, but I nonetheless wondered if I had overwhelmed him (did he even remember who I was?). Eventually I let it go and kind of forgot about the letter and Sara and him in the deluge of loss we face in oncology.
Years passed. On a random busy December day, I was in clinic and one of the front office staff came to get me, saying I had a visitor. It was Sara's husband. I didn't recognize him at all at first. He had cut his previously longish hair very short and shaved off his full mustache and beard since I last saw him. He looked tired and old for his apparently middle-aged age. As I approached him, I searched his face for clues of who he might be, not wanting to deal with the awkwardness of confessing I had no idea who he was. Then he stuck out his hand--the hairiest hand I have ever felt--and it all came rushing back. "You're Sara's husband. How are you doing? I hope you're not here as a patient..." (it is a Cancer Center after all).
He proceeded to ramble, standing right there in the lobby, how much he had loved Sara, how much he treasured that letter, how much it had quieted his mind that a stranger could see how much he loved Sara, reasoning that if a stranger could be so moved by his love for her, then surely Sara must have known how much he loved her, and how that was all he could ever ask for on earth. Then he said, "We always had a bunch of photographs and knick-knacks on our hearth. After Sara died, I cleared them all off. The only thing up there now is the urn with her ashes...and your letter. Anyway, I just came to tell you that." Then he turned and walked right out the front door.
I was too dumbfounded to say anything or walk after him, but in mind, I said to him: You just got in the sterile field all over again.
Tuesday, December 23, 2008
1. Cookies: My mother made dozens of cookies when I grew up: pecan sandies coated in powdered sugar, gingerbread cutouts, spritz, bourbon balls, fruitcake cookies, “painted cookies” (sugar cookies with glossy egg wash in corresponding colors) just to name a few. What we did with all of these cookies, I really don’t remember. Maybe we gave some away. We ate some for dessert nightly. We left a few for Santa. While I enjoy cooking, and cooking with my sons can be a lot of fun, I just don’t do it much. My mom gave me an appreciation for homemade baked goods, and I love that holiday tradition. But the boys & I don’t need the temptation of baked butter and sugar close by – Pillsbury, Duncan Hines, or my own.
2. Carrying a pager on 12/25/08: I’m on call for my partners and myself this year. The upside is that only the sickest of the sick children’s parents call that day. I’ll make rounds in the morning, and my kids are understanding about my leaving for an hour or two.
3. Stuffing things in bags at the last minute: I believe I have perfected the wrap in tissue and shove in snowman bag much as a quarterback throws a perfect spiral. It’s all in the wrist. My mom’s method is to wrap and then add beautiful ribbons and bows and embellishments. It also requires sitting. My method can be done as I am striding to the car on the way to a recital or party.
4. Looking forward to mother-in-law’s Christmas day because I don’t have to cook (much): My mom is an amazing cook. My family tradition is an English Christmas dinner with roast beef, Yorkshire pudding, parsnips and potatoes, and gravy. It makes my mouth water just to type those words. We lived overseas when I was in grade school, and adopted this tradition. I’ve alluded to my ability to juggle cooking and call – just not able to do it. I’m very grateful to my in-laws that they host the family for a covered dish get together. My husband makes his popular meatballs (another Crockpot winner!)
5. The internet: I shop (thank you, Amazon). I keep up with life, and blog: Where would I be without the ability to find and ship gifts to multiple places? My mother spent hours going from store to store searching for the perfect gift, packing them, and hauling the box to the post office. I do some of that, but the internet has streamlined the process so that I can continue to work full-time (a Pediatrician’s busy season) through the months of November & December.
A year ago, I didn’t know what a blog was let alone had an idea I would be writing on one with such an amazing group of women. Thank you. Mothers in Medicine! Thanks, KC, for giving me a chance to voice my opinion. Happy Holidays to you and your families & I look forward to the New Year!
Monday, December 22, 2008
But, reading the comments to my post where people shared the ways they give and show their children to give during the holidays was inspiring. I loved how Nurse Heidi holds a charity drive in her garage, how Laura and her mother bought gifts for kids on an Angel tree every year growing up, how Tempeh's extended family spreads kindness with every gift they exchange.
Saturday, we took my daughter to the mall (note: madhouse, avoid if possible) for the sole purpose of picking out a gift for a girl who wouldn't otherwise be getting toys this year. I loved watching her critically evaluating the toy aisles looking for a good gift. I have this! She would like this! She finally decided on a Little Mermaid doll, since Ariel is her favorite character. Note, she does not have one herself.
We went to the fire station yesterday and she dropped off the doll in the big box in the lobby.
As I walked back to the car, holding my daughter's hand, I felt such a connection to her. Such a tenderness. Such rich love. It was such a small act, this donating of a doll, but it felt like much more. It was, indeed, a beginning. A seed, I hope.
Happy Holidays, Mothers in Medicine.
Friday, December 19, 2008
Thursday, December 18, 2008
"These are attributes of physicians that serve them well professionally," said the presenter,* flashing a list onto the giant screen:
- perennial caretaker
- emotional remoteness
The family medicine conference attendees nodded and murmured in recognition, and he continued, "And these are the attributes of physicians that are liabilities in family life." He flipped to the next power-point slide:
- perennial caretaker
- emotional remoteness **
As the audience burst into appreciative, rueful laughter, I was struck by how neatly my domestic difficulties had just been explained.
I've often noticed that the very qualities that enable me to do a good job at the clinic frustrate my efforts at caring for my family and our home.
My days at work are organized exactly as I like them, from the length of patients' appointments to their medication lists to the position of the stapler on my desk. I interview patients, I examine them and I write prescriptions, requisitions and orders. I don't determine what walks in the door, but I manage every aspect of the problem once it's presented to me.
My life at home is an unpredictable, distracted mess. Much as I'd like to slot in a toddler bum wipe at 10:15 and keep the school backpacks stowed in the hallway closet, urgent requests and displaced things greet me at every turn. I may be the one guiding the day in a general sense, but the thousand details are determined by three messy, spontaneous children.
The satisfaction of measuring performance by objective standards at work cannot be achieved in the same way at home. I can pick up the faintest of heart murmurs, I can suture a laceration beautifully, I run my clinics on time, but how do you grade yourself on raising a daughter well?
At the clinic, I take on challenging work, complete it, and turn to the next diagnostic puzzle. But at home, I repeat menial tasks thousands of times, while others undo them.
Like most physicians, I thrive on competition. It's always motivated me, and winning is powerful affirmation. But motherhood is a different beast from the MCAT, pharmacology prizes and residency applications. No one's going to come out on top, and comparing yourself to other mothers is futile and dangerous ground. The competitive mother after gold stars is the one no one wants to be around.
The only item on the list to which I can't relate is emotional remoteness at home. My problem is the opposite. Because I am so emotionally controlled at work - probably because I hear the very moving stories of refugees every day - I tend to let any restraint slip away when I walk in the front door in the evening. I can be extremely irritable, though no one at work would ever believe it. Once, when I was being particularly foul, Pete gently suggested, "I think you should try to treat us like you would your patients."
I want to be a great doctor, and even more, a great mother. But if the qualities of one can be the undoing of the other, no wonder it feels such a struggle some days.
*Dr. Paul Farnan, St. Paul's Hospital CME, November 2008
Wednesday, December 17, 2008
One of the best things about having my son has been getting to relive my own childhood. What better time to do that than Christmas! The cookies! The stockings! The lights! As he’s gotten older we’ve started to watch the classic Christmas cartoons I loved as a child.
He has always loved Dr. Seuss, so last year we got him “The Grinch that stole Christmas” book. We read it for a couple of weeks, then we all sat down and watched the cartoon (not the Jim Carey version, the original). It was such a hoot. He loved it and it was as good as I remembered. We all had it memorized by the end of the season. Even though we packed it up with the Christmas decorations, throughout the year when anyone in our family said “I have an idea” my son would pipe up and ask, “Is it a wonderful, awful idea?”
This year I got him the “Charlie Brown Christmas” book and we had been waiting patiently for the special to come on TV.
But….. it was a little different than I remembered.
First of all, the whole premise of the show is a child who is battling depression. Not necessarily the feel good plot of the year. Seriously, any child psychiatrists out there want to give me a differential diagnosis on Charlie Brown?
Then there are the other kids who are just plain mean. Calling him “stupid” and “idiot” all over the place. My son’s eyes got huge. These words that aren’t allowed in our house.
Add to that, the complete lack of adult supervision. Where are the adults? Why can’t they talk?
The plot is a quite lacking in general. Although I did feel some nostalgic warm fuzzies when Linus recited from Luke Chapter 2 and they sang “Hark the Herald Angels” sing at the end.
At least Lucy has some good business sense for her practice. She collects her 5 cent co-pay upfront. I’m worried she might be violating HIPPA, though since she doesn’t seem to have any walls around her booth.
Tuesday, December 16, 2008
SLEEP: Do you go right to sleep? Are they actually sleeping right beside you?
FOOD: Perhaps you're eating your own dinner. Or is this the time to make their lunches for tomorrow? Or make your own lunch (or your partner's lunch) for tomorrow?
READ: Is it time to curl up with a magazine (The New Yorker? People? Time?), or read the web in its entirety, your academic journals, some fiction?
WRITE: catch up on emails, your blog, your list-making
CONVERSE: have at least one meaningful, or at least uninterrupted, conversation with your spouse/partner.
LAUNDRY: and all those other housekeeping chores, anyone shopping online?
EXERCISE: see next
SEX: in your dreams or in reality
What did I miss, is there anything else? Oh yes, some people probably go out. Is there life after the kids go to sleep (suddenly I feel like I am writing this in Carrie Bradshaw style, do forgive me, MIM pals)?
Monday, December 15, 2008
Truly, as I looked around the room the day of the exam, I felt as if I were in the inner sanctum of a (not so) secret society. The testing center was the house of the brotherhood. The examiners were the brothers/sisters, and I was the lowly pledge, so desperate to be on the other side of that imaginary line between junior fellow and fellow. It was all rather unsettling. I have been beating myself up since the test has concluded, and I'll have to wait a little longer until I discover whether I am "in" or whether I am "out." My family has been grounding me since my return home. To them, I *am* their inner circle, and, whether or not the brotherhood deems me worthy, I know that I can count on their radiant smiles and open arms to welcome me into our own little cozy inner sanctum. It puts everything in perspective, of which I am in great need. So, no more slacking, at home, work, or the blogosphere. The test is over, and life moves on.
Sunday, December 14, 2008
The argument is that if you're five minutes late a lot, how come you can't just leave five minutes earlier in the morning?? Good point.
I can't really use the baby excuse because other residents in the program have kids, so I mostly say something along the lines of "I'm a senior resident and I'm pretty much checked out." I'm embarrassed to admit the real truth, which is that it often is Melly that makes me late.
I have good intentions: I'm usually dressed and ready to go with plenty of time to get to work. But then sometimes as I'm walking out the door, I hear her crying... and I think to myself how rare it is that I get to see her in the morning. I almost never get to be the one to rescue her from her crib and give her a bottle while holding her. That's so much more important to me than any lecture could possibly be. I don't think my priorities are screwed up.
And of course, if I hear her cry "Mama!" there is no chance of me getting out the door on time. I'm not made of stone.
It's especially hard for me because there has never been a time in Melly's entire little life that I have NOT been a resident. Except for my 6 weeks of maternity leave, I've never gotten to have an extended period of time when I could wake up with her every morning and spend the day with her. Or even part of the day.
Those extra five minutes in the morning are all I've got and I just can't make myself walk out the door. It's well worth getting yelled at.
Friday, December 12, 2008
Then I saw KC’s pictures of her family. Sweet pictures to be regarded for years to come. Happy baby pictures. Sibling enchantment (however brief). Glowing parents. I want pictures like that!
So I’m on a quest for some visual memento of my seven and eleven year olds. How else can I freeze them in time? I want to capture Harry’s tossed salad blond hair, and Will’s prepubertal glow. Not only would pictures satisfy my mommy-lust for holding back the sands of time, I could use them as Christmas gifts for family and Husband.
One of my office staff showed me her Christmas pictures. They were urban and modern, and I loved them. Her website showed pictures of playful kids in old chairs outside. This photographer, like KC’s, had the gift of not only catching the image of the subjects but their spirit as well. Sign me up!
So we were all set Tuesday afternoon to meet this photographer after school. The rendezvous point was a field of wheat on the other side of town. Prior to this meeting, I had run all over town looking for the right wardrobe. I had settled on solid color sweaters and t-shirts, and had tried hard to pick items that the boys would wear anyways.
Will, Harry, and I piled into the car for the 20 minute drive to this field – my rough directions in hand. We dodged traffic lights. The boys muttered about interrupted play time, but understood that surprising Daddy was part of the adventure. I chatted them up about how much fun this would be – trying hard to keep the atmosphere light. We found the field on the side of a road, and pulled over to park and wait. We were a couple minutes late. No problem – we had 30 minutes of daylight left.
My first clue to impending failure should have been that the wheat was actually weeds – a disaster for my allergic seven year old. The second clue was waiting for 20 minutes with two antsy boys in the car. I’m not sure I would have wanted the pictures of that afternoon. Surly Will. Pouting Henry. To be honest, I was pouting like a toddler, too. The photographer left us in the field. No show. Nadda. Disappointment is an understatement because then I had to explain to Husband why the boys were so moody when we returned home. Surprise revealed. Ta dah!
Maybe a trip to Hawaii for pictures is not such a bad idea after all. Hmm….
Thursday, December 11, 2008
The potential is huge.
But, I've been recently having second thoughts about this Santa-biz. I don't want Christmas to be all about getting. Sometimes, the way she acts, I think: wow, you have no idea how lucky you are. Sometimes, she is a complete brat. How to make her understand how blessed she is? To appreciate the joy of giving gifts (in all senses of the word) to others? Can they get that at this age?
And then I think of my friend Jen and her daughter M and know that they can. Jen runs a homeless shelter in the Bay Area and M, very close to my daughter's age, helps out at the shelter from time to time. Hearing about M at the shelter is inspiring. Her daughter is sensitive, loving, empathic, and so utterly giving it takes my breath away. I want that.
It may be cliche to volunteer at a homeless shelter during the holidays but what better time to start a family tradition of giving? I want my daughter to really understand that people out there don't have homes, don't have food, and sometimes, the only difference between us and them is luck. I want her to know this intimately, more than the times she asked me why I rolled down the window at the stop light to give money to the man standing at the island. (Why doesn't that man have a house?)
So I'm looking for local shelters where our whole family can go and help. The experience probably won't overshadow the receiving of Christmas presents for my daughter this year, but I'm hoping it will be a seed of awareness, of goodness, that grows.
Wednesday, December 10, 2008
Thursday, December 4, 2008
I wish we videotaped or had transcripts of the discussion. We got great advice, from having a fire drill-like plan of what to do if we get groped by a patient or a fellow physician (which has happened to members of the panel), to how to answer (or not answer) illegal questions in interviews about how soon we were planning on getting pregnant, how to manage when our kids are sick, and other wonderful bits of information and experience.
The next morning, I was driving 4 year old Z to school. He was sitting next to the big contraption the catering company rented to me to keep the food warm for the event. He was confused, somehow thinking it was for me to bring food to the people at the hospital. I explained to him that I was still in school to learn to be a doctor, then I would go to the hospital to help people.
Z paused for a second and then asked, thoughtfully, “When you are a doctor and you go to the doctor place, will you still be my mommy?”
“Yes,” I said. “I will always be your mommy.”
“Will you still come home to me?”
Oh, kid, you’re killing me. “Yes, I will still come home to you.” In my head, I was thinking, sometimes, during residency, it may seem like I don’t. But I will always come home, eventually. When all the babies are born, all the sutures are closed, all the cases are presented, I will come home. And I will try to find out about your homework and listen to you and hug you and kiss you before I collapse into bed.
Mom TFH is one of the oldest people at her medical school. The other students learn from her various valuable life experieces: as a pizza delivery driver, a Denny's waitress, an art major, a health food store manager, a purple haired punk, a natural supplement researcher, a midwifery student, and a mother. She has two boys and is married to a public elementary school PE coach. Going to med school just didn't keep her away from them enough, so she is doing a dual degree (D.O./M.P.H.), is the president of the ob/gyn interest club, and applied for a research fellowship.
Wednesday, December 3, 2008
I had a stereotype in my head of male doctors as men who were constantly chased after by women, regardless of their looks or personality. I figured male doctors believed they could have any woman they wanted, and I didn't want anything to do with a man like that. Modesty is a quality I value highly in the opposite sex.
Over the course of my medical training, I've met a lot of men who fit that stereotype to a tee. It's been frustrating seeing the way (some) female nurses swoon over my male counterparts. I've been shocked at the attention some of my male colleagues have received from the opposite sex, when it was clear they would have had trouble even getting a date if they were in a lot of other professions. It's especially frustrating for a female physician to observe this, since a lot of men are intimidated by our profession; whereas a male physician is "a catch". Damn double standards.
Of course, I've met a lot of male physicians who have proved me wrong. (Mostly, those men didn't become surgeons.)
So in the end, I didn't end up marrying a physician. He's in the sciences as well, but not medicine. Although it might be nice if he could understand some of the more medically complicated stories from my day, I'm usually pretty glad I veered away from marrying a doctor. I wouldn't want to come home to a doctor any more than I want to come home and turn on House, MD. He's my much-needed escape from the medical world.
Another unexpected added benefit of not being married to a doctor is that now that we have a child, we don't have to concern ourselves with working out our call schedules so that at least one of us is always home. He's home every night. Lucky bastard.
But I'm sure lots of women out there will assure me that being married to a male doc is all that and more, as long as you find the right one.
Tuesday, December 2, 2008
So we have a girl now. And they are different than boys. With Son, I'd just lift up the penis and wipe up any poop on it.
With Daughter, poop gets mashed in between the labia, and I'm entirely freaked out using the wipes on such a sensitive area. And what if I inadvertently shove some fecal matter into her urethra? The state may not allow me to complete this adoption if I were to cause UTIs.
Husband laughs because I've had all this fancy training and I can't change a diaper.
To tell the truth, I've never been much into newborns, but this kid is special. She's mine.
We are having a stellar holiday season thus far. I hope your families are enjoying this season, too.
Monday, December 1, 2008
It is popular everywhere, evidently, to employ physician extenders to help get it all done. PAs triage patients in the ER and treat the more straightforward problems. Nurse practitioners make rounds on the critical care patients and the cancer patients, writing the detailed progress notes before the doctors arrive. They do casting for the orthopedists and see routine followups at the family practitioner's office. There's even a push for them to write prescriptions, although that's not happened yet in our state.
One of my partners has a PA. He sees 90% of his post-op patients at followup in the office, sees new hospital consults, does all his medical records, and screens all his incoming pages on call. He also often is the only person to see my hospital inpatients on the weekends when they're on call. This frees my partner up to be more productive and to have more time at home with his family.
So what's the matter with me? I admit, it's been very tempting to engage a PA myself. I'd love to have someone else dictate all those discharge summaries. I might even be able to see my family 5 nights a week instead of 3. How can that be a bad thing? Why don't I just hire somebody to help? *Everybody else is doing it!*
I just can't do it. Maybe it's a little OCD, but I keep hearing my mom saying to me years ago, "If you want a job done right, do it yourself." It's the mantra of my Type A surgical personality. I know you can't really do *everything* yourself, which is why we have an office staff. But when it comes to patient care, it's a different story.
My patients come to me because they trust me to help them. Most are in pain or critically ill, and they're vulnerable in so many ways. They are *my* responsibility. No one else can evaluate them initially, because I have to make the decisions about what patients need surgery. No one without surgical training can or should do that. In the hospital postop, there are so many subtle things that can go wrong, I don't feel comfortable letting anyone else other than my partners make rounds. (I dislike my partner's PA seeing my patients when they're on call, and my patients have told me they don't like it, either.)
In the office postop, patients want to see their surgeon, not somebody else. I want to see them, because it's rewarding seeing how they've (usually) improved as a result of what I've done. I hear patients complain frequently that "when I go to my family doctor, I never see him, just the nurse practitioner." (That attitude may be unfair to a very good nurse practitioner, but it's that patient's real response.) To me, it's important to nurture my rapport with each patient. I can't do that if I don't see them and talk to them.
There are real legal issues, too. If my PA misses something resulting in a bad outcome, that's my responsibility, and I take the heat. If my PA doesn't document something adequately, that can mushroom into a huge problem under the right circumstances. And if I check everything a PA does, it's not worth having them, because I might as well just do the work myself.
This is not to insult physicians who employ physician extenders or to insult the physician extenders themselves. It may be that with the growing population and the physician shortage, my approach may not be workable or realistic, just like house calls are a thing of the past. I may one day eat these words.
But for now, I'll keep treading water, doing my own thing.
gcs 15 is a 39 year old full-time neurosurgeon in private practice in a beautiful Southern state. She has a 10 year old son who plays travel soccer and ice hockey. Her wonderful, Type B husband is a primary care MD who quit medicine to be a college professor and loves teaching premed students. She adores her job but hates the politics involved in the practice of medicine. She's always struggling to find ways to get more hours in the day.
Sunday, November 30, 2008
"Attention all personnel. Attention all personnel. Code Indigo, third floor. Code Indigo, third floor."
I look at the nurses. "Indigo? Which one's that one again?"
Every hospital has coded security alerts for unusual events - emergency room on diversion, airway crisis or cardiac arrest, infant abduction, bomb threat, unruly patient or family member, etc. I don't recall having heard a Code Indigo* recently.
"Missing patient," says one of the nurses.
"Probably just went out for a smoke," says another.
I go to do post-op rounds. The all-clear sounds overhead for the Code Indigo. But when I get to the post-partum ward, a nurse there tells me as I leaf through a patient's chart, "Don't bother. You won't find that patient."
"No. Just gone. That was the Code Indigo."
"Oh! I thought I heard an all-clear a while back."
"Yeah, because the patient's definitively gone. Baby's still here, though. Wanna see?"
She lifts a swaddled bundle of warm, sleepy perfection out of a bassinette. The baby starts drinking formula from a small bottle the nurse is holding.
I start to think of another baby, a patient I had had to discharge to a foster parent during my internship. The baby had been hospitalized with bilateral spiral femur fractures. Yet every time I approached his crib to examine him, his face would light up with a bright smile that held nothing but joy. After I turned him over to foster care, I went into the call room, called my husband, and sobbed on the phone to him, utterly disconsolate.
My mind starts churning around my current situation, trying to figure out if there's some way we could take care of this baby ourselves. But of course we're not at all prepared for a decision like that right now; all I can do is call the social worker and make sure she's on top of what needs to be done to get this child into a suitable pre-adoptive home. It seems like such a small, ineffective measure to take.
The snow has turned into something a little wetter and clumpier. It's dark by midafternoon on days like this. I've turned on a mix of Christmas music - a little Nutcracker, some Kathleen Battle, a little Boston Pops and Leroy Anderson. I go back up to the nursery to hold the baby. The nurses welcome the break.
"Here, Dr. T - have a seat right here."
The baby sleeps in my arms. His cheeks bulge out like rosy little fruits. He is totally at peace. He has no idea that either nobody loves him at all, or someone loves him so much that she felt she had to set him free. He is blissfully unaware that he is alone in the world. Abandoned.
"At least she didn't try to flush him down the toilet, like the kid we got last week."
Thank heaven for small blessings.
Advent starts today: the liturgical prelude to the Christmas season, and the new beginning of the liturgical year. There's something in the baby's given name that conjures up images of light. Light, on this grey, darkening day.
"The people who walked in darkness have seen a great light." I wish, I wish, I wish.
I start humming the baby a lullaby. My favorite song of the season, half ancient chant, half carol for a newborn.
O Come, O Come Emmanuel
and ransom captive Israel
that mourns in lonely exile here
until the Son of God appear.
Rejoice! Rejoice -
Emmanuel shall come to thee,
I hope this baby gets his Christmas wish, the wish all babies are born with: a wish for love, for a life that matters, and for a world of hope to be cradled in.
*(Not the actual alert used.)
Cross-posted at Notes of an Anesthesioboist.
Saturday, November 29, 2008
It's been very interesting sharing the news of my pregnancy with colleagues, family and friends. The response I get is different for this third pregnancy.
With my first pregnancy, people were generally very excited for me. I was embarking into the world of parenting and people congratulated the decision and celebrated the novelty with me. I got lots of advice on how to manage the pregnancy and what to savour BEFORE the kids come.
With my second pregnancy, people seemed to react as though it was the natural next step. It was more a 'matter of fact' and parents with multiple children shared parenting advice on how to cope with the extra chaos.
With the third pregnancy, I find that the reactions depend on personal situations:
Those who are not yet married, or married without children, think I'm crazy to go for a third (they just can't relate);
Those with three children of their own celebrate the news and reassure me that life will just get better;
Those with two children (young and old) all recount to me how they came to the decision NOT to have a third, as if my news has made them revisit their decision;
And those with only one child feel the need to explain why they haven't yet had a second!
Ironically, even my husband has found the same trend in responses.
Regardless, we are absolutely thrilled and praying for a healthy pregnancy and baby and eager to hear any advice on going from 2 to 3!
Tuesday, November 25, 2008
As we pulled into the parking lot of the church where the meeting was being held we could see a steady stream of cars pulling up to the entrance. We parked in a far corner of the parking lot and while we walked to the building we watched people in wheelchairs and using walkers approaching the doorway and struggling to get through. As we got closer, I suggested that Youngest might want to hold the door for some of the people we saw. He looked at me sideways, but then ran ahead. I could hear him talking to a couple wrestling with the door (which didn't have any modifications for people with disabilities); then with a smile, he opened the door as wide as he could so that the husband could push his wife through. After he assisted a few more individuals it was time for the meeting to start.
Before I knew it, Youngest was talking with the facilitator of the group and passing around cookies and punch to the members there. He sat quietly while I spoke to the group and answered questions without bringing out his electronic toy once. As the evening was winding down, I was approached by a woman who had been sitting quietly in the back. It was obviously difficult for her to move forward, even with the rolling walker she was using. Watching Youngest's face, it was apparent that he felt removed from this group. I could almost read his thoughts, "Poor folks; too bad they contracted this disease. Thank God it will never happen to me." The woman thanked me for the information I had provided, and the enthusiasm and encouragement she felt I had brought to the group. And then she said, "You know, I've been battling this since I was 16 years old. I never thought I'd be around this long." Youngest's mouth dropped wide open at this point - with just a few words, this woman had made him realize that none of us are immune to whatever it is that our futures hold. Before I could say anything, Youngest had moved next to the woman and said, "I'm so sorry to hear that. May I give you a hug?" While I answered questions for another person in the group, I could see Youngest speaking softly with the woman.
Afterwards, he and I helped the facilitator clean up the napkins and cups. Youngest didn't say anything while he gathered up debris and placed it in the trash can. As we began to walk through the now-quiet parking lot toward our car I said, "I'm proud of you. I think you did a very nice thing tonight."
His response was typical pre-teen. "WhatEVER, Mom. Race you to the car!"
I wasn't sure how much of that evening Youngest retained, or what an impact it had made upon him until recently. As we were talking about the upcoming Thanksgiving holiday, Youngest suddenly blurted out, "I guess we can all be thankful that we're healthy, right?"
Right, son. And I'm thankful for lessons that are learned without trying.
And to all of you - I wish you a healthy, happy Thanksgiving (and quick healing to you, Happy Mom).
Monday, November 24, 2008
Sunday, November 23, 2008
Professor (who was also an orthopedic surgeon): "So what field do YOU want to do?"
Prof: "Christ, what a waste. You may as well become a veterinarian."
Prof: "You know you won't make any money in general peds."
Me: "I may specialize in pediatric endocrinology."
Prof: "They make even LESS."
Actually, I think if you do pediatric endocrinology, instead of getting a paycheck, they remove money from your bank account each month. So you really have to love it.
In planning my third year schedule, I took peds as my third rotation. If there's a specialty you think you really want to do, you're supposed to do it third. That way, you can decide early on if it's really for you, but it's not so early in the year that you're still a bumbling idiot.
Long story short, I'm not a pediatrician. I could say I hated the parents or that I had trouble looking in tiny ears, but really, it was that I couldn't deal with the sick kids... I mean, the REALLY sick kids. There was nothing more heartbreaking to me than an ill child. Even reading a fictional clinical vignette about a child with cancer ruined my day. It didn't matter to me that I was helping them or even saving their lives... I just couldn't bear it.
And now that I have a child, I am doubly glad that I made this decision. Every time I pass the peds floor in the hospital and hear children crying, I think of my daughter and my heart aches. Maybe I would have grown accustomed to it. I don't know. I'm grateful other doctors are able to distance themselves enough that they can do this kind of work.
Luckily, sick adults don't make me nearly as sad.
Saturday, November 22, 2008
I can't believe I almost forgot about this.
So, today, I started to think of who I should ask. How does one go about inviting someone over? I didn't want to make someone feel self-conscious about it, like, Hey, since you seem like you have no friends or family...
I decided to start with a general probe. I asked a co-worker whether she had family in the area. (Yes) Great! Back to the drawing board.
Driving home, I thought of one of my residents. The more I thought of him, the more I thought he might really appreciate an invitation. I impulsively called him. "Hey, do you have plans for Thanksgiving?"
"Why do you ask?"
It turned out well. He said he really appreciated the invitation and he'd get back to me. He also asked whether this could extend to some of his colleagues. "Sure," I said. Smiling.
I hung up and felt the most amazing rush of, well, euphoria. The thought of opening our home to residents who might otherwise be alone on Thanksgiving filled me with immense joy. I'm hoping, hoping that we'll have extra guests at the table on Thursday. And even if they don't come, this feeling of just extending the invitation is pretty awesome.
Friday, November 21, 2008
I had a great day.
The morning office went surprisingly smooth. I escaped for lunch to meet my husband and son at Cracker Barrel. This is quite a treat, I rarely get a full lunch hour, rarer still to get to leave the hospital. We had a pleasant lunch. Boy Genius was thrilled to get pancakes for lunch (husband also ate “second breakfast”). As we finished eating, I noticed that a few tables over was a lady sitting alone. Shortly there after, she came over to our table and with a huge smile handed my son a crisp one dollar bill and said “Happy Thanksgiving.” She then proceeded to take a our check and say “I’m going to take care of your lunch, and Yall have a blessed day!”
I was quite flabbergasted. I tried to protest, but she gave me a motherly “don’t even think about it “look. So we simply said “ thanks” as she walked away.
Her random kindness invigorated my spirit. I’ve spent the whole rest of the afternoon thinking of ways I could pass on blessings to others.
This may seem like a cheesy e-mail spam story… but I promise it happened to me today. My sadness is still there, but the self pity is gone and replaced with the reminder that this is the season to be thankful of our blessings and look for every way we can to bless others.
Thursday, November 20, 2008
Wednesday, November 19, 2008
On Facebook, many friends I meet again from my high school and college days ask if I'm still singing.
"What's gonna work? TEAMWORK!" (I loves me some Wonder Pets).
And let's not forget the Mail Song from Blue's Clues.
But here's the kicker. Son doesn't appreciate my musical stylings. He actually shushes me when I sing along. I'm crushed.
I thought myself brilliant once. But I'd take the role of mama over broadway star any day.
Tuesday, November 18, 2008
I got married near the end of my last year of residency. When I started medical school, in fact when I started residency, I hadn't yet even met my husband, and I didn't have any of the 3 kids I now have. That's probably a good thing because I would surely have talked myself out of the specialty I really loved into something more "family-friendly". There's nothing wrong with family-friendly, mind you. I always read the classified ads in the New England Journal just out of curiosity, wondering whether there are more part-time jobs cropping up as women, who more often work part-time than men in general, represent a greater share of young doctors. So far, I don't think much has changed in the job advertising sphere.
When I happen to have a bad day at work, which is fortunately rare, I permit myself to back up and take a different fork in the road. In my alternate life, maybe I became a dermatologist, where "full-time" seems to be 4 days a week...but who works full-time anyway? Or infectious diseases, where every other ad seems to start "Full-time or part-time". Ah, travel clinic...seeing some healthy people and getting them ready to travel to exotic locales. Lest fear of boredom be a factor, keep in mind that the occasional traveler will come home with a fever of 40.8--is it malaria? Dengue fever? Ebola? See, that would spice things up. And clinic finishes at 3p.
But snap out of it. I became a medical oncologist, had my first baby midway through my second year of fellowship, another baby at the end of my third year, and a third baby about a year and a half into my first "real job". At some point in late second year when other fellows were beginning to do their job talks and interviews, it dawned on me that I didn't want to be away from my son and his future sibs for 60 hours a week. I didn't want to miss first steps or first words or first anythings. It didn't feel right to me that someone other than me--indeed, someone I hadn't even met yet--would be there for more of my kids' waking hours than I would, and that's exactly what working full-time meant.
I starting looking through journals, online, anywhere for part-time medical oncologist jobs. Zip. Zero. Nada. I even tried monster.com, and all I got for combining "part-time" and "oncologist" is: Busy oncologist seeks part-time front office staff. Bummer. Oh, and did I mention that I had kind of subspecialized to one particular type of cancer. And can't move out of the area because my husband is in the military, unless they tell us to move, in which case I have to pick up and leave instantly. When I told people that I wanted to work part-time, and no I didn't want to just take a hospitalist job, and no I didn't want to work in an urgent care, and no I didn't want to review charts for utilization management or do life insurance physicals for a living, and yes, I did plan to work as a doctor, and yes, I did plan to work as an oncologist, and yes, it had to be in this area, they just looked at me with some blend of pity, empathy, disbelief, disdain, and said, "Well...good luck."
Six months later, I was agonizing over my choices: one job working 3 days per week as an academic oncologist, one job in private practice oncology working 2-3 days per week, and one job in oncology public health/health policy working anywhere from 2-4 days per week. All of them were within 30 mins of my house. All of them were in the particular subspecialty of medical oncology that was my interest. None of them was advertised. None of them existed when I interviewed. So, what's the deal?
If you happen to fall in love with a specialty of medicine that doesn't bear the family-friendly label, here are your career choices at the end of your training, assuming you aren't willing to compromise on the family side:
1. Let this specialty be the one that got away and pick something that's more family-friendly.
2. Train in your specialty, but work in a more general field with your specialty as your area of expertise (e.g. take a part-time internist job with an interest in pulmonary disease--a big group private or academic practice may be glad to have one internist who likes to see all of the asthma and COPD folks, there are plenty of them, and is comfortable with critical care if patients get admitted to an ICU).
3. Move beyond the standard black or white career paths--academic or private practice--and look at jobs in the government (FDA, NIH, CDC, etc), public health, the pharmaceutical industry, hospices, and so on, many of which are more amenable to part-time employees.
4. Interview for your dream job, whether academic or private practice or whatever, and give them enough time to decide you are their dream candidate. When they start trying to recruit, play your part-time card. Most will use salary or benefits to try to sweeten the deal. What you want is flexibility or fewer hours or whatever it is that you want. Take a deep breath, picture your kids clinging to your leg as you try to leave for work in the morning, and then speak up without apology. You will surely benefit from a part-time job if that's where your heart is, but there are also benefits to the employer, and you should point them out: cost savings (part-time employees generally accomplish more on a per hour basis than full-time employees and generally cost their employers less in benefits because fewer benefits are provided), greater loyalty (from grateful doctor-moms such as yourself who are committed to making part-time work work) and therefore less employee turnover, improved staff morale, and fewer absences from work (you can schedule the kids' well-child visits and your tooth cleaning on your days off, and , if you're lucky, some of their colds and vomiting illnesses might even occur on your days off). You will likely be pleasantly surprised. I interviewed for all of the jobs I mentioned above, and they were all full-time. After I made my priorities for recruitment known, all agreed to work with me to tailor a part-time arrangement. In the end, I actually created a hybrid of 2 of the part-time jobs I had negotiated, working a total of 3 days per week, and it has been wonderful.
Bottom line: If you assume it will be impossible to find a part-time doctor job in your specialty, it will be. If you assume it will be possible, then it will be.
Monday, November 17, 2008
Still enjoy playing the bongos.
Still enjoy seeing Grandma.
Still enjoy painting.
Still enjoy Clifford, Berenstain Bears, Mo Willems.
Still enjoy They Might Be Giants, Dan Zanes, Laurie Berkner.
Still enjoy wearing mittens.
Still enjoy going to the zoo, zoo, zoo, how about you, you, you?
Don't like too many snaps, buttons, and zippers.
Don't like wearing shoes when riding in the car.
Don't like keeping quiet.
Don't like coats.
Can't help interrupting.
Can't help staying up late.
But the jury's still out on stinky diapers, classical music, carrots, clothes with holes, tub time, hats...
Sunday, November 16, 2008
1) I remember as a kid, I used to love going down slides. LOVED it. Especially those twisty slides where you go through a long tunnel. In the last year, I've had the pleasure of going through a handful of slides with Melly on my lap, and every time when I get to the bottom, something hurts. Usually my butt. Those slides are treacherous.
2) Prior to a year or two ago, I had never experienced lower back pain. Never. When I was stooped over a patient for whatever reason, the attending would often warn me, "Be careful you don't hurt your back." I would scoff. Back pain? No, I'm way too young for that! But in the last year, I've had back pain constantly. So far, it's all just been muscle strains that got better in a couple of days, but I suspect I'm on my way to a herniated disc. I try to be careful... I tell my patients to take off their own damn socks for the EMG. I'm aware of the correct way to lift an object so as not to cause back injury, but it's hard to lift with perfect form when you're lifting a quickly moving, wriggling object, if you know what I mean.
3) I used to love roller coasters. When I attempted to ride a roller coaster a few years ago, I found that I not only did not enjoy it, but when I came home, there were actual bruises all over my poor back.
4) About a year ago, I found my first gray hair. I haven't seen any more since then, but I'm clearly still traumatized.
5) I still get the standard "gosh you look way too young to be a doctor are you sure you aren't still in grade school" response from patients, which I know most of us have experienced. The only difference is that now I'm really HAPPY when they say that to me. I don't even get fake insulted, like I used to. Then I get overzealous and injure my back while examining them.
I am impressed that people have kids after age 35. I'm not even 30 yet and as you can see, I'm already falling apart.
(Yes, I'm under 30 and complaining about feeling old... go ahead and mock me.)
Friday, November 14, 2008
And your next thought is gratefulness that the diagnosis does not preclude daycare attendance. Alarming though that will be to the non-medical parents.
(For the uninitiated, I posted a summary of fifth disease here.)
Wednesday, November 12, 2008
Posts will be publishing at regular intervals today so be sure to check back. Feel free to add your advice in the comments section, or if you are currently a medical student, what you think of our advice!
Scroll down to see the posts...
People in my medical school did not talk much about life, the universe, and everything. We were concentrating on the cerebral aspects of medicine, not necessarily the humanitarian elements, and not the life outside med school.
So if I did medical school again (and, yes, I absolutely would), I would take this advice back with me: have a human perspective on all things. During my training, we all tried so hard to be professional, but I think that, in the process, we started to ignore or even invalidate our own feelings. Our emotions and reactions may not always need to be open and visible, but it's okay to feel the burden of your patients' experience and not be closed off to it. I think too many people have the fear that allowing themselves to feel too much will cripple their medical ability. I don't think so.
In my years since medical school, I have seen many of the best and brightest doctors from various disciplines getting their hands and their hearts dirty (so to speak). They have an intimate knowledge of their patients, and I see how they are invested in their patient's care. These professionals have taken down the wall that is supposed to exist between the medical brain and the feeling person underneath. I have immense respect for them and the care that they provide. They manage to be involved, yet they don't make inappropriate recommendations or have nervous breakdowns. They just see the patients (and themselves) as the human beings that they are.
These are my role models, from my unique spot from behind the microscope. But if I were a medical student again, I think I would allow myself to feel a little more sadness, frustration, helplessness, and love.
Lesson #1 has a couple of corollaries. The first is do what you love and the rest will follow. Sometimes what you love changes, and be willing to follow that path, too. It’s ok to reinvent yourself midlife (or sooner) if you decide another field suits you better. Six years ago, I decided to apply for dermatology residency. It was a period of time that had me reaching for the stars, but I had to do it to be happy with my choices. Derm programs are very choosey, and no program wanted to pick up a practicing pediatrician and put them back in the rigors of residency no matter how glowing my letters of references or work experience shined. Instead, I opened my own general pediatric practice, and have found success and happiness in the autonomy that followed.
Corollary number two is if you have wealth as a pediatrician, it is best not to flaunt it. Maybe your great, great uncle with no children left you a trust. Maybe you can get away with driving that Porsche in a really upscale area. In my suburban community, I often encounter parents and patients when I’m grocery shopping or making a Starbuck’s run. They check me out – what car I drive, whether it has a booster seat in the back, what shoes I have on, what’s in my shopping cart. There’s something about taking care of sick and miserable children and displaying luxury possibly gained (or not) from delivering this care that is incongruent to me. It may be the stuff of deep pockets that malpractice lawyers and litigious patients look for. Save the pictures of the fabulous vacation in the Caymans for home.
Lesson number two is that in pediatrics lifestyle and money are two choices (of many) that may determine your path to happiness. One of the beauties of my specialty is that it is family friendly and very flexible. One of my colleagues is getting back into the workforce right now after three years absence. She needed time to care for her daughter with Type 1 Diabetes. Other physicians choose to work part-time or job share. In my practice, I have learned that I deliver the best continuity of care with my patients if I am there at least three days per week (I average 4 days per week), but I also employ a physician who works two days per week and takes no call. My compensation is higher because I see more patients. Her lifestyle is different than mine because she is part time.
Primary care is a production business, and that’s something to consider as you make your choices in medicine. During a typical work day, I need to see at least 23 patients to be able to pay my overhead – office staff salaries, lights, medical supplies, insurance filing fees – before I pay myself. I’m conscientious of this because I own my own practice. Whether you work for yourself or are employed by a major healthcare system, general pediatrics is about seeing lots of patients. Employers track these numbers, too, and compensate you accordingly. So if you like to chat with your patients like I do, you’ll see fewer and be paid less than the guy down the street who sees 60 patients per day and says very little. My whole office is a beehive of activity each day to accomplish each patient encounter. When I hire new staff, I let them know up front that pediatrics is fast paced.
Why, you may ask, have you focused so much on the economics of medicine when all I need is advice about how to be a good clinician or balance my family life? The body of knowledge needed in medicine in infinite, and I am humbled daily by what I don’t know. Yesterday I encountered two new medicines I had never heard of before reading a specialist’s notes. Your focus in training needs to be on assimilating as much of this knowledge as possible. The reality, though, is that medicine doesn’t exist in a vacuum. Eventually you will need to take all you have learned and apply it to the world we live in with all of its variables (insurance, national quality guidelines, patient compliance – just to name a few) – broken healthcare system and all.
Right now you are, no doubt, a very "big fish" in a little pond. You are probably known as the smartest, most ambitious, and most masochistic, ahem, of all your friends. In medical school, you'll be surrounded by 100 + of people just as smart, ambitious, and masochistic (if not more so) than you. You will probably be, maybe for the very first time in your life, average. And as much as that may give you angina right now, you need to know that "average" is actually ok! No, really!
You thought you studied hard in college, but you are in for a surprise. You *did* study harder, relatively, than anyone else you knew. You also routinely got paid off in As. In medical school, you will sit in the same position for 8-9 hours a day, pausing only for bathroom breaks and pasta, reading, re-writing notes, and reading again, only to score an 80% on your exam. You need to go to lecture, but if you don't go to lecture, then you need a good note service, and, unless you are a hell of a good transcriptionist, if your medical school employs a lot of professors with thick accents, then you will probably need to ante up the cash for someone else to transcribe "your share" of note service lectures. Take some time to go "off campus" for lunches with your friends, and allow yourself to skip a lecture for a mental health hour every now and then. It will be worth it.
The first two years of medical school, you will work, and study, and take tests, and drink copious amounts after tests, and wonder why in the world you ever wanted to go to medical school. Keep the faith. The MD/PhD candidate that sits next you in the third row and your gross anatomy lab group will likely form the core of your best friends throughout your four years together, even though at times you want to throttle all of them. Familiarity breeds contempt, but you are all going through the same hellacious experience. You will value these memories, even if you don't believe it now.
You will have a med school fling. It will be fun, but won't last (and you'll be totally ok with that.) You will make mistakes. You will fail (yes, I said FAIL) a test. You will cry, a lot. You will feel like everyone else smarter than you. You will wonder, more than once, if you have chosen the wrong path. You haven't. You will eat too much, drink too much, and exercise too little. Try to take better care of yourself, that extra hour of studying probably won't make a difference, but that hour of exercise could mean a healthier you four years from now. Don't forget about your family and friends. Try to stay in touch with the people that mean the most to you. Their support is important. Life is going on outside your little microcosm, and you'll be sorry that you lost touch with the friends that knew you before you became a med bot.
Once you start clerkships, you will remember why you started doing all of this in the first place. Taking care of patients! You will *like* what you are doing again, and, all of the sudden, some of the lectures that seemed like absolute nonsense will actually begin to become more clear. No matter what you think you may want to do, clerkships will change your perspective on everything.
Be a good student. Know your patients. Have the patient seen and the notes written before your (overworked) intern hits the floor. Keep a running list of scut that needs to be done on *all* patients on your service (not just *your* patients, remember, you are working as a team) and be sure it is done before you leave the hospital. Check in with your resident/intern often, they are too busy to page you, but you may get to see (and do) some cool stuff if you stay visible. Learn how to write orders and practice whenever you can. Do everything you can to make your resident's life easier. Write prescriptions, skeletonize discharge orders ahead of time, and offer to get them food if you notice they haven't eaten. Stick close to your resident on call, but *go to bed* if they tell you to go! Don't try to show off how much you know, it is obnoxious and will likely come back to bite you. One of your patients will likely die, and you will never forget it.
Once you find out what it is that you want to do when you "grow up," be sure to make yourself known to the residents and attendings in that specialty. Ask lots of questions. Find a resident that needs help with research and offer your data gathering skillz. If it is a surgical specialty, make an effort to scrub in on as many cases as you possibly can. Center your fourth year electives around the specialty early in the year, so you can make the proper connections for letters of recommendation. Make yourself invaluable to your team. It will serve you well no matter what specialty you choose.
Even if you have met the love of your life, and think that January is a wonderful time to get married, think twice about planning a wedding in January of your fourth year. That is right in the height of interview season, and you will cause yourself undue stress trying to plan interviews around your wedding! The good news is, it is quite possible to nurture a fledgling relationship through the stresses of medical school (and it will prepare your spouse to be twice as awesome as he supports you through the worse stresses of residency!)
When you finally finish medical school (it is a marathon, not a sprint!), you will not be the same person that you were. You will be in debt up to your eyeballs, literally. It will take you years (some as an indentured servant) to pay off hundreds of thousands of dollars just for the privilege of being tortured, erm, learning for these last four years. You will realize that you will never be "rich," like your classmate that quit second year because he was making more money day trading stocks than the average family medicine attending. However, you will be a physician...fallible, over-educated, and under socialized, and you are going to help patients in ways you never even considered when you first sent in your application.
All the best of luck (you could use a little of that, as well),
Future Dr. Whoo
I had just finished a particularly grueling internal medicine rotation and I was feeling fairly disenchanted. When it came to be my turn, I said, "If I were a first year med student right now, I WOULD QUIT."
Everyone kind of stared at me in shocked awkward silence, then quickly went on to the next person.
But you didn't come here to read that kind of advice, so I'll give you some revised sagely advice from an even older and even wiser me: I wish I had taken a year or two after college to see what else was out there, instead of going straight through to med school.
It seems like the happiest people in med school were the ones who were in their mid-20s when they started out, instead of 22 like I was. They had taken a few years to see what else was out there and realize that it wasn't for them. Oddly enough, some of the people who were significantly older seemed to be just as disgusted as us young'uns, possibly because many of them had families that med school was taking them away from.
This is my graphic representation*:
I wish I had taken a couple of years off. At least then I could stop romanticizing all the stuff I didn't end up doing. Maybe I would have realized that being an actuary (i.e. calculating insurance rates for companies) isn't such a fabulous career, despite how nerdishly excited I get over making a graph (see above). And I could have written that novel I always wanted to write... about the compelling protagonist with an obstacle to overcome, where some friends become enemies, some enemies become friends, and at the end my main character is richer from the experience... (you get the idea)
*Graph not based on actual data
Hey you. I don't mean to blow your mind, but I'm you, writing from the future. No, you are not on Punk'd, I assure you. You don't believe me?
Well, I know you have a crush on that cute guy in your class you went to coffee with the other day. The one you talked to for hours, losing track of time. You are going to be married in 6 years. I know, score! Your wedding day is going to be the most perfect day, ever, complete with birds chirping and a gentle breeze blowing. Don't be scared by the weather forecast. The clouds will literally part that day.
Are you with me?
I wanted to pass on some advice because I think it will save you a lot of stress and anxiety. Listen, all of those years of stress and anxiety about everything from career choice to thoughts about the future and families really can add up (really add up = multiplying white hairs = a return to getting highlights again = major upkeep commitment = $$$). So, in essence, I'm saving you time and money by sending you this note.
1) Go with you heart when choosing a specialty.
I remember how much you wrestle with this. I know it's hard sometimes to imagine what you might like to be in the future, but whatever you choose will have to sustain you intellectually over the years. Do what you love. Do what challenges you. Your career is going to take a few unexpected turns (I'm convinced that it always does), but it will lead you to where you are now, in the future, and it is so meaningful and fulfilling for you. If you love what you do, you'll find a way to have the kind of life you want in that specialty. You'll "make it work," (reference to a show in the future that you will absolutely adore.)
2) Having children does not mean giving up on your career.
You may think now that choosing to have children early on in your career will necessarily mean a hiatus from doing anything productive, career-wise, for many, many years. You may be resigned to not being able to accomplish your career goals because of this. Don't. Because I'll tell you that having time constraints because of your family can make you that much more productive during your other times. You'll have rushes of creativity, of ideas, moving ahead productively in ways you would never have imagined.
3) Having children will make your life unbelievably rich.
It's amazing. It's all that you dreamed of and more. Go for it. (But, no need to rush in - enjoy the alone time with your husband - travel, explore, really solidfy your two-ness. Children are wonderful but you'll miss that two-ness later on.)
4) Take calcium supplements now. Hello, peak bone mass?
5) When making your residency rank list, remember that it is MOST important to be around people you love who can support you, not the fine details of the program.
6) Dream big.
Don't stop setting high goals for yourself. Don't settle. As a woman in medicine, as a mother in medicine, you can do great things. Dream big.
See you in the future,
Dear Fat Medical Student,
You worry too much. It's gotten you this far, but enough is enough.
Years from now, it won't matter if you get a 92% instead of a 100% on an exam. You won't care if a resident thinks you are lazy for wanting to leave just two hours late. You won't even remember your step one score, but you'll remember the hangover from the celebration upon passing the test. Years from now, your patients will love you because you care. They won't care if you don't know all of the answers as long as you know how to find them.
You'll be a family doctor, a combination of all of your "favorites"...internal medicine, pediatrics, obstetrics/gynecology and psychiatry. You'll know a little about a lot of problems but not a whole lot about any of them. You will be comfortable referring to specialists. People will tell you their deepest secrets and will care about your opinion. Don't let them down.
Years from now, a lot of your "hero" teachers will seem emotionally immature to you once they are your colleagues. You'll watch them be cruel to ancillary staff, students, their families and, heartbreakingly, some patients. You'll feel superior to them in all ways other than raw knowledge. Don't put them on a pedestal until you are sure they deserve it.
Don't be so desperate to find a mate now. You will marry your best friend and have happy children. You'll see.
Years from now, you'll be sorry you quit walking the dogs when you got a fenced yard. You'll regret those drug-rep bagels, too. Stop when you are 15 pounds overweight and you'll never be 140 pounds overweight.
You will hurt many patients...not with malice but with honest mistakes, misjudgments and quirky fate. Decide now how you will handle it so it doesn't kill you. You'll cry about these circumstances because you are a good person, but don't let the bad outcomes make you jumpy.
Years from now, you won't care about money because you'll have some. Save for retirement and live below your means. Your loan payments will be a small part of your overall salary because you borrowed wisely.
Years from now, you'll find yourself wanting to snap at people in "ordinary" life. Practice now how to manage fatigue so you don't become an ass. Medical students will turn to you for a kind word or emotional support and you should give it. Always.
You'll be glad you spent time with your nieces and nephews even when finding time was difficult because the children make your life whole. Invest love in them and it shall be returned when you are back in diapers.
Years from now, you'll be a generally happy person. Of course, you'll wonder what might have been in you hadn't chosen medicine. You'll consider chucking it all and going to cosmetology school. Don't let your mind go there. On the day when you decide you are in the wrong career, a patient will tell you that they credit you for helping change his or her life. It will feel good.
Enjoy the success...it's what you wanted.
Future Fat Doctor