My Final Answer

I know it may not look like much is going on here in this blog, but I continue to get e-mails from people asking the same question:

As a doctor, when's the best time to have baby? Before or during medical school? How about during residency or as an attending physician? Which specialty should I go into based on my desire to have kids?

I think I have my final answer, really, the end all be all answer. It's beyong cliché. . . but here goes: Accept your callings in life.

If you're a family wo/man, have a family. If you always saw yourself with six kids, think about how much time that would take and subtract it from the latest you'd like to be pregnant and go to it. Something will work out, it alway does. Yes, it will be unbelievably hard, but chances are if you signed up to become a doctor you're a glutton for punishment anyway.

This blog has been brutally honest (as I've been told) about the challenges of becoming a physician while trying to start/raise a family. So long as you go into this process with your eyes wide open, good coping skills, and at least one supportive buddy everything will turn out fine.

Deal with the fact that you'll miss 'firsts.' -You should have known that when you sent in your medical school application. Since none of us remember if mommy and daddy were there when we began walking, just remember that you're more likely to suffer emotional damage than Junior when it comes to absenteeism in the first years.

What children need, says me, are parents who give them their best selves in their formative years (generally accepted as age 3 and beyond). This doesn't necessarily mean, but doesn't exclude, staying at home with them. If you were called to be a homemaker, do it. If you were created to be a doctor, do it. It really doesn't matter what occupation you find yourself in so long as you set a good example of using your talents and giving examples of service. Consider the opposite: A mother who resents her children because they kept her from her career aspirations, or the work-horse who returns home too burnt-out and bitter to enjoy her kids.

The trick here is to choose a specialty (or profession for everyone else) that will build you up to be a better person. -This is where the caveat to my final answer comes. If God blessed you with the skills of a surgeon, but the lifestyle would make you and everyone else miserable, don't do it. Pick the next thing on your list of favorites. Trust me.

Finally, doctoring isn't always the thorn in the side of parenthood. The one perk to being a resident mommy is that when I have to say goodbye to my son, I can always tell him that I must go help others who are less fortunate. I was on-call last night and missing my little guy terribly when I was summoned to see a six-year old boy who was complaining of pain at his gastric-tube site. On the way to his room I saw several children with broken skulls and displaced eyes. You better believe when I came home I held onto his perfect little body longer and with more appreciation than I would have otherwise.

Coming eventually:

• Patriotism and Decluttering - A match made in heaven.
• Living life pre- and post-call
• Are women the cause for the healthcare crisis?
• The "I can't seem to lose this stomach so I'll just have another baby" option.

Grab Your Ankles

In the tradition of higher learning.

So imagine you landed the lead role in your high school play. Yippee, right? But now envision giving your lines on opening night without much practice, and as you make mistakes in front of everyone you get called out by your director. Oh, I forgot to mention that in this exercise of imagination, each goof-up puts someone's life in danger.

That's what it's like to be a resident learning procedures. I got a nice verbal equivalent of a paddling in the OR today. I know the Socratic method is "see one, do one, teach one," but how about 'see many, get hand-held through a few, and then do one'?

When I'm told that I am not good at something, and it's because I'm either inherently incapable of the task or that I'm a screw-up it's really hard not to cry. But that's the last thing I'm allowed to do. Plus, it makes all female doctors look bad.

I was feeling pretty down when I grabbed my lunch. Across from me was a surgical resident and as soon as he finished his sandwich an attending physician came in and started pimping* him. He didn't have the correct answer and the same thing happened. The poor guy was told, in front of everyone, that he really needed to wake up and start learning.

Frankly, there's not a seat soft enough for our bottoms today.

*This is the actual terminology for blasting your inferior medical resident/student with questions on the spot.

An Unfair Depiction

But I'm not tied down to my breast pump.

Y'know, when the Mormons were first asked to practice polygamy most of them went kicking and screaming into the practice. Then when they were commanded to stop, they had a hard time letting go. That was my experience with breastfeeding.

The gap in posts had to do with me being on my most demanding rotation while soaking in the reality of my academic situation. . . all the while working to save someone's life (I'll explain later, on 1/20/10). I had always said that I would stop pumping at the 6 month mark, but just before the finish line my supply went down. . . WAY down. It had to do with a ton of stress and my inability to find time during the day. I became all hung up on the idea of stopping on my terms, not because I was 'failing' to produce.

So I got all worked up, pumped more, fell behind in my work, this added stress, which produced less milk and the cycle continued! Until now, that is. Last week I produced 2.5 ounces, gave my boy this meager portion, and put my supplies away. The large box of nursing pads, bras, tubes, valves, shields, etc got sealed up and put into storage. Part of me was elated; the other part felt terrible for withdrawing this part of myself from my baby. The next week as my normal pumping hour approached I had pangs of regret and actually tried to collect whatever I could manually squeeze out. I came home quite upset when my husband finally said, "It's time."

He's right. 6 months of breastfeeding for a resident mommy is a lot. My baby is on solids now and I can help him to progress in other ways. I'm told I can still feed part-time, but the truth is I need every minute of the day (except for necessary sanity breaks such as this) to reclaim my life.

A Pain in the Neck

I had hope for the future . . .

But then I destroyed my neck. I hurt it by using a bad side-lying position to breastfeed my sick baby all night on Saturday. The following day I went to pick him up and heard an awful tearing sound coming from my cervical spine.

The irony is, people in the medical field get the least mercy when they are ill or hurt. If you're having fevers, puking, or got the runs you're still expected to come in. A torn muscle? Puh-leez. So I tried to endure the first few days of my new rotation, but here I am typing this post from home. . . unable to look anywhere except straight ahead.

I actually don't have any sick days to use because my maternity leave (a whopping 5 weeks) ate them all up. I'm using the last of my vacation days, which I had reserved for emergencies such as this and/or my brother-in-law's upcoming wedding . . . in Japan. Sadly, this time off might mean I can't go anymore. (If you're reading this Paul and Mayu, I'm soooo sorry!!!)

I couldn't have imagined I'd hurt myself this badly. If you consider that I gave birth to my son who was face-up without an epidural and now I'm tearing up from pain you know that this is bad.

Just trying to rest up and pray that I'm OK by tomorrow. Because this resident mommy must get back to work.

Back from Conference!

Sorry about the pause in posts (did anyone notice?), I just got back from a medical conference in Austin, TX. There's me with my poster about a device that can help paralyzed patients get around, and with a fellow resident mommy!

Many, many way cool pictures to follow. . .

Tips for Pumping - Thanks Marketing Mama!

Check out this awesome how-to guide from Marketing Mama on how to pump successfully at work. It is an awesome resource!

I would like to add a few things from my limited experience. These are tips specific to being a doctor, but can be applied to any mother who is extremely pressed for time.

• Check in with the RN station beforehand = Get things in order first
  All residents quickly learn that if you want uninterupted time, you speak with the ancillary staff to find out if they need anything from you before you take care of yourself. Nothing cuts off a milk letdown like hearing your pager go off in the middle of pumping, and I imagine the same is true for moms who hear their children screaming for something when they've just gotten settled.

• Say it straight-faced = There's no need to get embarrassed over pumping
  Doctors hardly blink an eye when they hear about body parts and functions. The truth is, if you don't make a big deal about something it doesn't become one. In contrast, if you're red faced every time you say 'breast' that's going to have a positive feedback response from the person hearing it. So just say what you need to say to communicate with people your needs for pumping breast milk. -Tee hee.

• In case of a Code Blue = In an emergency. . .
  Detach the tubing from the breastshield and bolt. If you remove the tubing from the pump itself you will not be able to lay the bottles on a flat surface and run. And don't even think about spending the time to transfer your milk to another container when your adrenaline is pumping.

• Type progress notes while you pump* = Go hands free
  There's that goofy looking bra you can wear to hold the breast shields in place and many mothers swear by it (I'm not knocking them, but c'mon, don't tell me that picture doesn't make you crack up). I recently found, however, that my Playtex nursing bras have enough elasticity in them that they can be clipped around my pumping parts and actually hold them in place!

• Consider your rotation schedule when returning to work
  Don't jump back into residency with an in-patient month if you can help it. You'll be too tired and literally drained to get through it well. If your schedule has already been made, see if you can switch with another resident for an elective month.

• Create an involuntary pathway = Train your brain
  Repetition will limit the amount of time it takes you to pump, and hopefully limit mistakes that will eventually happen when you're sleep deprived.

• Build your reserve by the end of maternity leave
  This is really difficult as a resident because most of us get only 6 weeks off, the end of which usually marks the time when baby is going through a demanding growth spurt. But if you can push yourself to have a nice supply sitting in your freezer, a HUGE weight will be taken off your shoulders and you'll be a milk machine.

* Marketing Mama brings up a good point that you should just focus on your baby when you're still getting into pumping.

I'll Shut Up Now

Throughout my pregnancy I kept telling myself that at least I didn't have it bad as my friend, Kate. The poor girl went through months of hyperemesis gravidarum then started her intern year of general adult medicine. She was put to work like you wouldn't believe, sleep deprived, and under an enormous amount of stress and pressure. After all that her maternity leave was short despite having to undergo a c-section.

The quote that will live in infamy was uttered by Kate's senior resident when her water broke during morning rounds and she was wheeled away: "Are you coming back?!"

Reflecting on my own pregnancy, labor, delivery, and recovery I've been thinking lately that I might not have it in me to do this again. It would seem even more daunting the second time around, knowing what I know now. So what news do I receive today? Kate is pregnant again and is due during her last year of residency. What?!