Saturday, May 31, 2014

Sleep

The sleep requirements of my almost 2.5 year old have decreased over the past few months.  Previously, she'd do about 11-11.5h at night (until 7:30 in the morning sometimes -- I KNOW), and a 1.5-2h nap in the afternoon to round it out to about 13 hours.

Lately, it's been more like 12 or maaaayyyybe 12.5 hours.  Now she goes to bed at 8:30 or 9 and still gets up at 7 or 7:30 and takes a 1.5-2h nap in the afternoon.

Dammit.  I needed that extra me-time before bed.  It was when I finally got to unwind for the day. 

I know this is all a prelude to when she drops her nap completely in 6-12 months.  Fortunately, I will be a resident, so I will (I hope) only suffer minimally when this happens.  I suppose on the positive side, we'll stop having to plan our days around her nap schedule as much.  On the minus side, that means WE will have to go full steam ahead all day long.

Grumble grumble.

Fortunately she has started to sometimes play with her animals in her room for a while by herself.  It is my hope that with her decreasing sleep needs will come increasing independence and less need for constant hypervigilance.

Ha.  Good luck to me on that one.

Friday, May 30, 2014

Year

Med school is too long: Discuss.

No, seriously, between the dead time between 3rd year med school and starting my PhD, and the months of September through... now, during which I've done exactly 6 weeks of clinical anything (plus 1 week of bioethics), I feel like I have wasted SO MUCH TIME waiting for things to start. 

Of course when you're busy, you're in a dead sprint the whole time, and all you want is a break so that you can catch your breath.


Ugh.

I am trying to enjoy my last few weeks of freedom, really I am, but it's hard to feel like I'm not wasting time. 

Wednesday, May 28, 2014

Nope, you really can't win

I have a couple of friends who are first time moms doing the whole obsess over supply/exclusive breastfeeding thing.  While going back to work.  It's hard for me to listen to them.  I remember how awful that time was for me, being tied to the pump constantly, dealing with the pump room arbitrator, being excessively worried about my supply, actually being successfully shamed into not using formula when my daughter was EIGHT months old by some 23 year old bitchy nurse who had no children of her own and, let's face it, had a pretty easy gig working over at student health and was in no position at all to provide commentary on my life.

My daughter never did get formula, and I will tell you now -- it was NOT worth it.  Particularly those last 6-10 months when she was eating food.

I hear my friends talk about how now that their babies are sleeping through the night, that they are getting up in the middle of the night to pump.  How exhausted they are.  How they are barely keeping up with supply.  How stressed out they are about it. 

I remember feeling those exact same things.* 

I want to be tell them that everything is ok.  That they can feed their baby breastmilk or formula and still be great mothers.  That it's important to take care of yourself in order to take care of your family.  That being a mom isn't a competition that they have to win.  That it's nobody's business but their own how they choose to feed their kid, and all the shaming/competing/negative energy that women devote to making other women feel bad about not choosing the EXACT SAME THING THEY DID is really counterproductive.  That whatever they decide, their reasons are legitimate and I support them. 

But the thing is, you can't actually say any of this.  Because no matter what you say, it will be interpreted as a) unsupportive, b) that you failed, so you're now trying to get them to fail too, c) that you were weak but they are not, d) that you are shaming them, e) that you are encouraging them to give up striving for perfection.

So I just say nothing.  

I hope if I ever have a second kid I'm able to avoid getting wrapped up in this nonsense, but knowing myself, I doubt it will happen.  I'm probably the worst of them all.


*Though I will never EVER get up in the middle of the night just to pump.  That's just freaking insane.

Monday, May 26, 2014

If I didn't become a doctor....

If I didn't become a doctor I would:

  • Get a job working for a think tank
  • Do outcomes research or clinical trials for a pharma company
  • Work for the government doing health policy
  • Work for one of those new companies that come up with metrics to assess doctors and hospitals
I'd probably get paid more too.  :-P

On the side, if I had time, I might:

  • Have a second kid
  • Spend a ton of time with my daughter at the park, doing art and music, and reading and playing games in the house
  • Actually go to our community library
  • Join the local tool library and learn something about home improvement
  • Take care of my garden so it's not just a jumble of weeds
  • Write poetry
  • Exercise enough to actually get into better shape rather than just to stave off the inevitable decline
  • Cook dinner for my family more than every so often
  • Visit my parents more
  • Visit my in-laws in Italy more than once every 4 years
  • Start swimming again
  • Make friends with non-doctors
  • Volunteer at my daughter's school
  • Go see more community theater
Instead I will spend the next four years learning to assess patients, develop assessments and plans, stick needles and tubes into people (preferably mostly while unconscious), and do a ton of paperwork, and sleep about 50% as much as I want to. All the while being told I'm not good enough or smart enough, and probably that I'm not nice enough either.

Remind me again why I want to become a doctor?

Friday, May 23, 2014

Problems everybody has

This has been a banner week of sucking.  That is, sucking of the money from my bank account.  It's like God looked down and thought, "Things look like they're going too well for that one.  I see it's been a while since she's had some expensive crisis.  I think I shall cause her car not to start and her electricity to go down." 

If I were a better person, I'd just thank God these things happened this week and not over the holiday weekend.  Or during residency.  And that my house didn't burn down.

But damn, I'm gonna miss those $500.  Of course this is the month I don't get paid.  OF COURSE.  :-P

Note to everybody:  Car ownership is expensive.  Home ownership is expensive.  Having a kid is expensive.  All three can become inconvenient at the most inopportune times.  We all ought to be able to catch a little slack when these things happen, alas our jobs are not built that way.  Moral of the story is be kind to others because one day you're going to need a dose of that kindness right back at you.

Thursday, May 22, 2014

Friendly advice

At graduation, we had a speaker who was a member of the class of 1964.  She was the first African American woman to graduate from my institution.

I think the most interesting thing she said was that she was 9 before anyone ever told her that women, in particular black women, did not become doctors.

I had a similar experience in life.  In fact, nobody ever told me that I couldn't (or shouldn't) become a physician scientist until I matriculated here.  Ever since then, I swear not a month goes by without someone drawing attention to my gender or status as a mom as evidence that my career as a physician scientist is doomed to failure.

Sometimes this is direct advice (You should pick a field that will let you spend time with your kids, and that you will like, you know, in case your science career fails).  And sometimes it is less direct (Reading a piece on the mothers in medicine forum or at slate dot com about how we really can't "have it all" -- whatever that means -- or about how as a mother, being with your children as much as possible is more important than anything else). 

Maybe it's because the internet and social media are so much more present, and allow these topics to be in your face all of the time.  The funny thing is that these people, and these articles, purport to be helpful.

They are not.

I really need to go on a can't-have-it-all detox.  It's just those articles are like crack.  Ugh!  Can't.  Avert.  Eyes. 

One thing is better now than it was 50 years ago, at least now I can do whatever I want (or try to).  I just have to stick my fingers in my ears and ignore all the naysayers surrounding me. 


Tuesday, May 20, 2014

Off

One of the other women in my program who also had a baby during her training reported to me a while back that when she was on elective, one of her attendings found out that her husband had moved to another city for residency and that she had a small child at home.  For the record, she had the situation totally under control and had arranged the necessary childcare.

The attending gave her every Friday off for the rest of the 4 week block!

(I know, right!)

Every person I've told this story to who doesn't have children has expressed resentment that this person was given extra time off.

I tried to imagine how I would have reacted had I received a similar offer.  Truthfully, I think I wouldn't have welcomed it.  I wouldn't want to be seen as the person who needed or wanted to take time off to be with her family by either a) the attending, and b) the other students.  As weaker OR as someone who got special favors because of my reproductive status.  And also, I'm I was(!) in med school to learn!  I wanted to take advantage of this opportunity, whether or not I had a kid.  I didn't want special consideration.  I wanted to prove to myself that I could do it just like everyone else.  

And I could.  So could my friend.

And there are assumptions behind the offer.  Like, you're supposed to want to spend as much time with your children as you possibly can, no matter how interested you are in the career opportunities that present themselves to you, and no matter how well covered you've left your family situation so that you can do both well.  That your kids are more important than your education EVEN TO YOUR BOSS, and that every opportunity you get at school or work there on out will be colored by the -- but she has kids can she really do this -- overtones.

If I were faced with a similar offer, I have to be honest: I think I would have wanted to turn it down.

The problem is, I don't know whether I would have felt like I could have refused.  Would the attending have been offended?  Would she think I was a bad mom?  Bad woman?  Unappreciative?  Failing to take advantage of the last time in my whole life when I'd have that opportunity?  Missing out on my child's childhood for no good reason?  And if I had taken her offer, would she have written me off as weak? 

Plus, if I have to be honest, I will also say that I actually like my life better when I am balancing working in the hospital and being a mom than when I have to be home all day long by myself with my progeny.  Within reason of course.  There were times last year when it was 8PM and I was basically just silently following the attending around watching her write notes on not-very-interesting follow-up patients (with no teaching interspersed).  At those times, going home to put my daughter to bed would have been really nice, but that's probably true for people without kids too. 

What would you have done if faced with a similar offer? What if there was another med student on the team who didn't get offered the same thing?

Sunday, May 18, 2014

2 things

Today, I graduated.  I am officially an MD-PhD.

In addition to those two degrees, over the past 8 years (only!) I have also amassed:

husband (1)
house (1)
dog (1)
daughter (1)
white hair (too many to count)

I found out two things today, both of which made me very happy:

1. If I'd gone to MGH, I might be starting as early as June 8th!  Yuck!  (My orientation starts 6/18)  I know this is something that you proooobably shouldn't consider when making your rank list, but it does seem like something that might be nice to know more than... oh, 2.5 months before you have to uproot your family and start spending 80 hours a week at the hospital, for... you know, PLANNING PURPOSES (for those of us with lives).  Thank you again, medical establishment, for withholding information from us unnecessarily, and making things harder than necessary. 

2. The "hard" rotation, as viewed by the interns in my program is viewed as an "easy" rotation as viewed by the internal medicine interns who also rotate there.  This probably made me happier than is either reasonable or healthy. 

Oh also, my daughter got to come up with me on stage to get my diploma.  I was a little nervous that a giant meltdown would happen while we were waiting in line....  First she wouldn't let me give her an uppy, and then she wouldn't let me hold her hand.  While I was getting hooded, she wandered over to the dean handing out diplomas and he tried handing her the diploma.  She stared at him and wouldn't take it.  I was afraid that she would start running wild all over the stage, but she didn't.  She was very charming.  In all the pictures my husband took, all the very important faculty who were up there could be seen smiling radiantly in her direction.  She totally stole the show.  Many people remarked to my husband how adorably lively she is.  :-)

After the ceremony she ran all over the venue, between legs, up stairs, on chairs and tables.  She ate quiche and cake and drank orange juice and totally had a blast. 

I have the best kid in the entire universe. 

My husband is a saint for chasing her around for me.

Thank you sweetie!

Saturday, May 17, 2014

Let's make it a tech free day

Went to see Oedipussy last night with Luca for an unexpected date night.  Au pair was able to babysit at the last minute.  The play was awesome.  Hilarious.

Parents are arriving today for graduation.  Need to:

1. Go grocery shopping
2. Get shoes for new dress (I have exactly 0 pairs of dress sandals)
3. Go for run

That's really not that bad.  Plus the daughter is with the father at gymnastics now, so I have some time.

I've already checked all important emails.  So, aside from 1-2 more checks today, I am going to try to stay off the internet for the rest of the day.

We'll see how it goes!

Friday, May 16, 2014

We're not normal

I've noticed in the past few weeks that my daughter has started to lie to us.  For instance, she will say that she wants to go upstairs to "Be by herself," or to, "See mommy," but I know damn well that she really just wants to go play with the Kindle. 

I recently read an article that said that kids normally start lying when they are about 2.5 years old.  Is it normal that my response to her lying is, "Honey look!  She's lying to us!  That's really advanced!  She's not supposed to do that for another couple of months!"*

Haha.

I swear we will start working on her moral development ASAP.  Right after she stops being so freaking cute. 



*This is not an invitation for you to tell me that your child started lying at 18 months.  That's not the point of this story, and I don't care.

Thursday, May 15, 2014

"Our parents made it work," and other logical fallacies

Occasionally (I really ought to know better by now) I find myself in a conversation with someone who tells me that I'm crazy.  Kids just don't cost as much as I say they do, our parents made it work, and things will just work out eventually if we just hold our noses and jump.  We just have to trust that it will happen!

Sigh.  Oh how I wish that were the case.

Let me tell you how my parents made it work, living on the Upper East Side of Manhattan in the 70s-90s. 

1. They had a rent stabilized apartment.  I.e. they paid $1100/month to rent a two bedroom apartment in a doorman building located in a nice neighborhood.
2. They only had one child.
3. Tuition at my private school cost a lot less than it would now.  I want to say it was 1/5 of the current cost, but I could very well be wrong about that.


Now:

1. That $1100 apartment would go for $4000-$5000 now.
2. Tuition at the same kindergarten is now $37,780 per year.
3. At those prices, I don't know if I ever would have existed.

The world is a very different place than it was when you came of age, guys.

Similarly, I have a friend in the Bay area who bought a 3 bedroom house just across the Golden Gate bridge for roughly $300,000 in the late 90s.  It's in a decent school district.  She got that money when her company went public.  Two things here: 1) most people aren't seeing that kind of payout from an IPO anymore like they did in the late 90s,  and 2) that house would now go for somewhere in the $800,000 range. 

People are not lying when they say that they think that my generation might be the first not to do as well as the generation before us.  It is true.  And it really WON'T "just work out" for a lot of us.  Well, it will work out, but we will end up living in neighborhoods that aren't as good as where we grew up, sending our kids to schools that are measurably worse, and hoping and praying that it really doesn't matter (it does). 

So in sum: Times are tighter now than when you were a kid.  Things often don't just work out for people.  Life does go on, but often in a very different way than what you planned. 

I'm sure you want to get home so you can spend time with your child

I hear this ALL THE TIME at the hospital, almost always from people without children (but perhaps that who I'm surrounded by). 

I suppose if I were smart I would say, "Oh yes.  Every moment I spend apart from her is pure torture.  Please send me home now."  The only problem with saying this is that one day someone (who has kids) will laugh at me and perhaps (deservedly) never let me live it down.

What I say instead is, "Actually, what I really want is to go home and lie on the couch.  Preferably with a glass of wine (just like you do)."

Usually the person laughs.

Occasionally (and this ONLY ever comes from people without kids) a look of horror will come across the person's face and you will know that you have just violated everything that they think a good mommy should feel, say, and be.

I have a couple of childless friends in the latter camp, and if I am honest with myself, I will say that it has become really difficult to converse with them ever since I had a kid. 

(The other thing childless people tell me is that I am wrong -- children don't have to cost a lot!  Their parents did it!  This is a post for another time.)

I really need to a) find new friends, and b) learn to let the judgements bother me less.  Neither of these things is easy to do. 

By contrast, you know you've hit the jackpot when the person laughs.  In terms of finding a person who gets it.  One such person commented on how wonderful having an au pair sounded because they could cover date night, so you could actually spend time with your spouse.  Yes!!!  Totally.  Another person nodded with understanding when I said (at 7:45 at night) that I was really torn about going home then because on one hand, I'd get to see my daughter, but on the other hand, if I stayed out I would get to miss the before bed tantrum that was most likely about to ensue.

I love my kid.  She is awesome.  But I don't need to see her 100% of the time.  I need to be a person to.

Wednesday, May 14, 2014

Best

The best part about being a med student is when you correctly diagnose your parent with a basal cell carcinoma.  Not.

On the plus side, at least it wasn't an MI this time.

:-P

disability

I was perusing the benefits that I will be eligible for as a resident, and it struck me as ironic that they only provide disability insurance to cover 60% of your salary.  Every other job I have had, it covered 80% (can't remember for what term though).

I was thinking: Is residency so awful that if they offered 80%, there would be a real moral hazard problem, and too many residents would be tempted to injure themselves in order to avoid having to go to work?  And at 60% you'd be paid little enough if injured that it just wouldn't seem worth it?

Something to ponder. 

Picking mentors

At this talk I went to last night, the speaker (as all speakers do) gave props to the outstanding mentorship that he had received while in graduate school.  He received most of his mentorship from his PI.  Is it possible (or better, even?) to cobble together mentors for different areas of your life, and end up with the same outcome?

It got me to thinking about the areas where I've had good mentorship, and where my mentorship has been less than stellar.

A good professional mentor:
  1. Gives you the tools you need (data, expertise, collaborators) in order to be productive.
  2. Provides guidance in developing your projects so that they have the greatest impact, but not so much guidance that they are no longer your own.
  3. Does not micromanage your projects to death.
  4. Puts mentees / collaborators with mutually compatible interests together so that more projects can blossom out of the relationship.
  5. Gives you resources that enable you to get your work done (computer & other computing resources, office space) without giving you huge amounts of grief over it.
  6. Encourages you to go to meetings, while at the meetings introduces you to people.
  7. Gives you mentorship on how to conduct yourself professionally, and how to network with other people in your field.
  8. Puts your name forward when appropriate opportunities arise that he/she hears about.
All of these things take time.  And honestly, it really works out best for everyone if your mentor likes you personally as well as professionally.  Not saying it's not possible if you just aren't their cup of tea, but the best outcomes come from teams that just click.

As a mentee, you pay them back by:
  1. Being productive as hell
  2. Playing nicely with others
  3. Making them look good
  4. Telling everyone who seems interested what a great mentor they are, and how smart they are.  Provide specific examples if possible.
I hear from a lot of women that they wish that there were more mentors in academia who provided examples of how to balance work and life.  I have a couple of thoughts on this:
  1. You don't get to be a star in your academic field by "balancing work and life."  You get there by pouring yourself into your work, being amazing at what you do, and by being lucky.  
  2. Nobody is going to give you permission to take time off for your family.  You have to decide what you are comfortable doing, and do it.  If you are productive as hell, probably nobody will care that you left early last Wednesday to see your son's soccer game.
  3. If you talk about how well you balance work and life too much, many people will assume that you are not working all that hard.  
  4. Stop looking for everyone to approve of your life choices.  
  5. Figure out what balance makes you happy and pursue that.  Be aware that you may find that your preferred balance is incompatible with the time commitment involved in becoming a CEO.  There should be no shame in that.  If that turns out to be the case, please do us all a favor and don't whine about how anti-woman the workplace is after you get passed over for that promotion for someone who is more productive than you are.
Other advice I want:
  1. How do I project myself as someone people will take seriously?
  2. When I am networking, how do I get people to see past my youth and female-ness, to see that I am a good scientist?
  3. How do I figure out if I am good enough at what I do to justify asking my husband to quit his lucrative job to follow me around the country and support my career?
  4. How do I form relationships with potential collaborators and attract talented mentees?
  5. How do I feel more confident? 
  6. Is building a great research group a matter of luck or skill?  How do you attract smart people who are also good to work with?

Tuesday, May 13, 2014

Kg

Went to a graduation talk tonight for my MD PhD program.  It was interesting, I guess, if you're into biochemistry.  The speaker was an alum of our program and a hot shot.  I think he's like 43 or something.

Anyway, at the very end he had a spiel about his 2 year old daughter (bet his wife's not 43....) and how important it was to make carving out time for your personal life a priority throughout your career.  And I just thought, Please God, don't make her be a kindergarten teacher or SAHM.  Because I just can't stand to listen to another successful man opine about the good life and the keys to success when he has someone at home to do the all of the heavy lifting for him. 

It turns out that wasn't exactly the case... but it is true that basically his wife had to give up her career to move with him to his new job. 

So yeah. 

Woo role models.

Wait, you mean they don't really care about helping me????

One of the things that I find most amusing is when a group of people gets together to lobby for more on campus daycare.  See the thing is, we already have one.  And it's full.

In theory, anyone can send his/her child there.  However in practice, the daycare is used as a carrot for the university to lure and retain faculty and other important people.  For most people, see, there is a 2 year+ wait list.  However I've met several people who said, "Huh?  There's no wait list at that daycare."  Those people were: 1) famous faculty member, and 2) relation of [very important hospital administrator].

Why does anyone think that adding another daycare on site will help anyone, in particular residents, whose working hours fall outside of normal daycare hours.  A new daycare would serve the same purpose as the old one.

What is the real purpose of the on campus daycare:

1. To enable to University to appear family friendly (yay PR!)
2. To attract and retain famous faculty
3. To remunerate people with power/money already in the institution

See, if they really cared about helping families with children, they would provide a childcare subsidy so that people could put it towards childcare that fit their particular family's needs.  But that would be expensive.  And, it would do nothing to further the primary purpose of University sponsored childcare that a too-small daycare center doesn't already do. 

Sorry to be so cynical, guys.  But that's the way the world works.  And I'm not really interested in furthering some cause that will only benefit the hospital CEO's grandniece.  Because she doesn't need my help.

Sunday, May 11, 2014

How can you spend even one minute apart from her, knowing that residency is around the corner?

My husband and I are going out to dinner at [fancy restaurant] tonight to celebrate 1) my birthday, 2) mother's day, and 3) graduating from the best MD PhD program in the galaxy.  I am looking forward to it.  I've wanted to go to this restaurant since I read about it on the kindle while nursing my daughter at 2AM a little over two years ago.  We just haven't been able to make it work until now.

I'm done (obviously) with most of my med school stuff, just trying to get a couple manuscripts out the door before residency starts.  I sent one off to my PI on Friday right before I went to pick my daughter up at daycare.  A doctor who sends his kids to my daughter's daycare asked me if I was keeping busy, and I said, "I better not be after this week."

Which begs the question (dun dun dun), will I be sending my daughter to daycare now that I have less to do each day.  And the answer is HELLS YES.

Yes yes, I know this makes me a selfish mom.  I know I'm supposed to be spending as much time with her as possible right now because when residency starts I will see much, much less of her.  The problem is, I don't want to spend every waking moment of every day with her.  It doesn't make me happy.  I can't get anything done.  And for goodness sakes, aren't I also supposed to be trying to enjoy myself these last few weeks of freedom that I have too?

(Don't answer that.  I already know what the answer is: No.)

You know what the worst is?  When I pick her up early at daycare in the hopes of getting an extra hour or two of "quality time."  But the problem is, all that happens is that I extend the time from the early evening through bedtime where everyone is cranky, and most of the day's meltdowns occur.  I.e. Hell time.

Oh, the stall techniques she employs to avoid going to bed.  Oh the tantrums when she doesn't get her way!  Gah!  Kill me now!  It is such hell.  The nightly ritual of crying because she wants to stay out at the park 5 more minutes, and then crying because she wants to stay in the bath 5 more minutes, and crying because she doesn't want to put on her pajamas, and crying because she wants to play with the kindle, and wanting another story.  And another.  And then requesting that her blanket be adjusted 15 times before I refuse to go back in her room despite loud protestations that I am the meanest mommy ever.  Neither of us has fun.  Hell, the park isn't even fun because the threat of a tantrum looms prominently, as does the threat that she will run into the street and get hit by a car.

And then I feel guilty (which is stupid) because I didn't enjoy the extra time I spent with her.  In fact, I just spent the last 2 hours wanting it to be over.  And then I collapse on the couch to watch 40 minutes of tv before bed because she has drained the last few ounces of energy I had out of my body, along with my will to live. You don't have to lie to me:  I know it wasn't fun for you either.  My awareness of the finiteness of the next couple of weeks is heightened, as I anxiously contemplate how I can be a better mother to you AND enjoy the time we spend together.

So, instead I'm trying to carve out blocks of time with activities.  Outside the house activities.  Where we can spend quality time together.  For instance, on Tuesday she will be staying home from daycare to (wait for it) go to the dentist.  Haha.

Sorry that I can't do better than that right now, my darling daughter.  Maybe we can do something fun before we head over to the dentist to count teeth.  Next time I promise to come up with something that is actually fun for us to do.

Saturday, May 10, 2014

Stop telling me how hard it will be!

I swear to God, every time I run into someone I haven't seen in a while, and they find out I'm finally graduating and starting residency, they say something like:

But don't you have a two year old?  Gosh, that's going to be really hard!

Thanks guys.  Thanks for your support.  Can you hear that creaking?  That's the sound of my eyeballs rolling around in my eye sockets.  If they roll too much harder they might fall out.

Look, I fully expect that the time demands of residency are going to be challenging.  However aren't I allowed to be excited to be completing one big step of my journey and starting on the next one for just one second without someone reminding me that as a mother, residency is going to be especially awful for me?

Ever heard of the word, "Congratulations!"  Or maybe even, "It will go by so fast you'll be done before you know it."  Because that's what I hear people without kids -- and men -- get told as a matter of course.  But no.  I get, "She'll be all grown up by the time you're done!  Aren't you sad you're going to miss it?"

Grrrr....

It is SO not productive.

Friday, May 9, 2014

Why do residents get such sucky maternity leave in the US

I am guessing that some residents want to take as little maternity leave as possible.  It is important to them to be able to return to their professional lives as soon as possible.  There's probably also an element of wanting to prove to oneself that you can do it (knowing what I know about doctors), and not wanting to delay the painful and low paying training process any further.  If this is what you want to do, it should be FINE.  I wish women who chose this path weren't thrown under the bus and told they were anti-woman or bad mothers.

The problem is, not everybody can do this.  There are physical reasons, and there are financial reasons, since childcare costs a lot, and not everyone's mom can just do it for them.  And there's the minor issue that newborns sleep badly, and trying to care for a 4 week old baby at night while pulling 12 hour shifts may result in an impaired resident.  Furthermore, some people don't WANT to do this.  These people have perfectly legitimate reasons for wanting what they want as well. 

I'm one of those women who hated maternity leave.  I was very isolated and really wanted to get back to work as I didn't want to delay graduation for another year.  Perhaps I would have felt differently had I not started my MD-PhD program when I was 29!  But anyway, I got 8 weeks officially, and unofficially started doing work at home on my dissertation about 3.5-4 weeks into it.  My in-laws came at 9 weeks to provide bridge care before we got into our daycare (which didn't turn out to be all that helpful in retrospect -- sorry guys -- I would have been better off with a mother's helper).  And then at 14 weeks a daycare spot opened up and I went back "full time," i.e. about 50-60 hours a week.

It was actually pretty ideal for me.  I was able to ease back into things at my own pace, get stuff done.  I do wish I'd been less socially isolated, and ideally would have done work outside the home earlier on.  However I really can't complain too much.

Contrast that to what residents are expected to do: Return to work after 6 weeks (8 if you have a c-section), or less.  And by "work" of course that means 80 hour weeks and call.  I hear that some programs try to give residents an "easier" rotation when they come back... whatever THAT means.  I gotta say, it sounds pretty cruel and unusual.

Look, I am not one of these people advocating for mandatory 6-12 months of maternity leave for everyone.  I would have gone completely bonkers if that had been the expectation placed on me.  I love to work.  I love interacting with other adults.  I love what I do.  But physically?  I have serious doubts that I would have been able to come back to a full resident work load post-c-section <6 weeks.  Even with a vaginal delivery it seems like it would be brutal because of sleep deprivation resulting from taking care of a newborn. Twelve weeks would be positively dreamy by comparison. 

What I want is as follows:

1. Better paternity leave so that husbands actually CAN help their wives.  My husband got one week, which is ridiculous.  Women at his company get 6 weeks paid.  I want parity. Even if most men won't take it, they should have the option.
2. Adequate coverage at the hospital so that residents aren't pressured to come back before they are physically ready, and don't face abuse if they choose not to do so.
3. Flexibility in taking longer leaves as necessary.  If you want to take 6 months, it should be possible to do so if you make up the time later on.
4. An option to ease back into things part-time earlier on into maternity leave for people who want to.  

I am not an administrator so I have no idea how feasible or infeasible these proposals are.  What do residency programs in other countries do differently that enables them to be more flexible?  Is it purely financial or are there cultural elements to this as well?

parenthood

Lately I've been watching the show Parenthood on Netflix in the evenings after my daughter goes to bed.  Yes, I know if I were a good person, I would be reading.  However I prefer tv.  So there.

Anyway I like the show, but it's starting to really piss me off.  It's just so.... how shall I put it..... anti-woman.  I'm in the middle of season two, and so far I have the following examples:

1. Joel is tired of being a SAHD, so when Sydney goes to kindergarten, he resumes work as a contractor.  He is ostensibly great at his job and finds it very rewarding.  However he finds that he can't leave work as planned to pick up the kid at kindergarten, so he asks his wife -- a corporate attorney -- to repeatedly leave work and do it.  When she says she can't keep doing this, his response is, "Well *I* did it for the last 5 years, now it's your turn." Wait, huh?  Ok, so he's ok cutting their income by 70-80% when she gets fired for being a flake.  Right.  What I really want to know is why the heck they don't either a) hire a babysitter to do pick ups, or b) put Sydney in after care at school.  You know, like practically every other working family under the sun does.  But no, instead we are supposed to think that Julia is being unreasonable and Joel is right.  *headdesk*

2. Jasmine leaves her son with her mom and Crosby so that she can take a prestigious dancing job in Europe.  Everybody in the family makes it clear that they find this completely unacceptable behavior for a mother.  Ultimately she sees the light herself and discovers that she really misses her family and quits her job to move home.  No mention is made of how she is now supporting her family, because, apparently that sort of thing is only worth mentioning when the man's employment involved.

3. Kristina is a SAHM whose children are both in school.  It is unclear what she does between 8-3 all day, but presumably it involves grocery shopping, scheduling appointments for her autistic son, going for walks with her neighbor, and providing emotional support to people.  As she no longer has her own professional identity, when her daughter runs for class president, she micromanages her daughter's campaign, and then becomes personally offended when her daughter asks her to back off.  She has an opportunity to go back to work for a weekend, and it is the most fulfilled she has felt for the past 16 years, but instead of making this a more regular part of her life and hiring additional support at home, she says (and everyone agrees) that it's best if she puts her personal aspirations and happiness aside for the good of the family.  WTF??

4. The only people who are apparently capable of providing adequate childcare are female family members.  It must be noted that if you are a teenage girl Braverman, you must be prepared to drop anything at a moment's notice to provide unpaid childcare to one of your many relatives, and do so with no complaint.  No such expectation exists for male teenage children (i.e. Drew).  Similarly, only grandma is an adequate babysitter.  Grandpa does things like feed his grandchildren fried chicken (gasp!) when he takes care of them, and is therefore completely unfit.  He admittedly cannot take care of himself and does have poor judgement about virtually everything, however that particular example was pretty laughable.  Obviously anyone outside the family is inadequate.  No Braverman would pay for some stranger to take care of their children.

In sum, Parenthood promotes sexist stereotypes.  I recognize that this is just a tv show.  However it is a tv show that is purportedly showing a diverse set of family structures (traditional, single mom, unmarried parents living together, working mom with SAHD).  NOT ONE utilizes childcare provided by a daycare or babysitter that is not a family member, and not one has two parents that are employed outside the home because of this issue.  Come on people!  This is not an uncommon way to run your family!  And in each episode, we are reminded that good women sacrifice for their families, even when not doing so would have no negative impact on their families whatsoever. 

Thursday, May 8, 2014

Post-call

I was talking to a man whose wife had a baby when he was a resident.  When his baby was little, when he was post-call, rather than go home he would go sack out in a call room until 6 or so in the evening for some uninterrupted sleep.

I still don't know how I feel about this.

On one hand, his wife had been home taking care of a newborn by herself for the past 30-36 hours.  It's likely that she didn't get any sleep the night before either (or the night before that or the night before that).  Him staying at work to sleep gave him a break that she would literally never get.

On the other hand, he had just been up all night caring for patients.  And would probably be up again at least somewhat that night (though let's be realistic about how much since they didn't divide night duty evenly either) as well.  It was also important for him to get some sleep.

Either way, the amount of cumulative sleep debt in that household sounds astronomical.  I hope that at least they had some helpful family nearby.  If we are ever in a similar situation, I hope that we have the money to hire a night nurse to help at least some of the time.  Thank god they only stay infants for a short amount of time.

Wednesday, May 7, 2014

Being a mom brings people together

One of the things I noticed after becoming a mom: I have something in common with a LOT of other people!

I was thinking about this earlier today after a conversation with another person whom, when I met her several years ago pre-child (for both of us), we got off on totally the wrong foot.  Now when we see each other we have -- I dare say -- enjoyable conversations about our offspring.  I have learned a lot about being a mom in my city because of my conversations with her.  She has become such a great resource for me, and I can say I genuinely like her.  Without kids we might never have figured this out!

Similarly, on a recent ICU rotation, I found that I could talk to the nurses much more easily because we had having kids in common.  I mean, I don't exactly spend the time talking about myself or my own kid.  Mostly I ask them questions about their kids, am fascinated by their responses, and learn a great deal.  And I look at a lot of baby pictures.  I also feel like with some of them, they learn I have a kid and somehow maybe this makes me more relateable.  I don't know, whatever it was, I felt that much more comfortable approaching them when I had questions about patients, and given how much I still have to learn about critical care, let me tell you this was a good thing.  Perhaps this was just an idiosyncrasy of that particular rotation, perhaps the nurses were particularly awesome on this unit.  Whatever it is, I will take it.

I also felt like on Peds rotations, or any rotation with an Ob component, having a kid gave me a little extra cred among the staff -- doctors and nurses alike.  Maybe I just felt more confident with the little babies and laboring moms, I dunno. 

Has anyone else had this experience?

While I certainly wouldn't recommend having a child to gain social acceptance, I have to say that it was an unexpected bonus of having a kid myself.

Tuesday, May 6, 2014

Hypocricy

When I was getting my ppd placed yesterday, I had a conversation with the nurse who urged me that if I wanted to have a baby, I should do it as soon as possible. 

Now, I get what she's saying.  I'm not getting any younger, and many MANY (not me) people think it's best to have kids close together so that they have each other and for logistical reasons.  But, 1) we're still very much on the fence about having a 2nd, and 2) I'm about to start intern year.  If I got pregnant tomorrow, the kid would be born in like February.  And since this is a prelim program with 16 other interns, chances are at least one of them would get fucked over if I had to take an 8 week maternity leave unexpectedly.  And yes, it would have to be 8 weeks since the plan is to have an elective c-section if there ever was a #2. 

If I am honest with myself, I have to admit that I'd be pretty annoyed to find out that someone got pregnant intentionally just before intern year started, only to drop that bomb on everyone else just as we start intern year.  Yes, I'd try to be supportive (though I'm sure it would be unappreciated, given that every med student under the sun wants to appear as though they do not need any help or advice), and no I would not take it out on that person or anyone else.  But deep down I would be pissed.  Especially if I had to give up an easy rotation or vacation.  I think it's only natural.

Later on in residency seems like a much less big deal, at least for my program, because there are SO many residents, and because basically every female anesthesia resident in existence has a baby sometime during her training (slight exaggeration, but not really).  It's a bit more expected and therefore the program is better able, in theory, to accommodate it.  But intern year seems like it would be a disaster, at least in my program.

On the other hand if I were the pregnant person, I would probably be telling myself that I can't let medical training steal my life away, or some such.  So there's that too.

Monday, May 5, 2014

Does medical training prepare you for motherhood, vice versa, or neither

When I had my daughter, I received a LOT of, "Oh you only think this is hard because you haven't done residency yet.  You'll see."

It wasn't that my daughter didn't sleep for more than 2 hours at a time for the first three and a half months of her life.  It wasn't that she was colicky. It wasn't that I exclusively breastfed.  It wasn't that my husband left for work at 6:30 every morning and returned home at 7:30 every night.  It wasn't that I had no other help.  It wasn't that after 4 weeks, I resumed working on my dissertation.  It wasn't that my own family was unhelpful, my in-laws don't speak English and live overseas, and all my close friends lived out of the area, and the friends who lived in the area were medical students without children.  I.e. they viewed my difficulties as something to compete with me about.

No.  It wasn't any of that.  It was because I was weak.

Thanks guys!  I really appreciate your support!

Suffice to say, I haven't done residency yet, but I have to think that sure, it's not easy either.  However it is completely different.  I also don't think that much of anything can prepare you to care for an infant all by yourself for Q1 shifts x 3-4 months or until your baby starts sleeping through the night, whichever happens later.

I also hear that being a mom has prepared me for residency.  Ha!  I personally think that's a total crock.  Will being a mom make residency harder?  Sure!  Will I be more prepared because I have a kid?  Um, no.  I really doubt it. I feel as incompetent and unprepared as anyone else starting off.

I will say, having a kid has made me much more empathetic to my patients.  In fact one of the reasons I couldn't do peds was because of all the parent bashing that I heard on a daily basis, which I noticed all the more after I had a child of my own.

Also, when patients say they have no time to do things like exercise, the knee-jerk reaction of most physicians is to a) assume the patient is lazy, and b) assume the patient just isn't prioritizing it.  After becoming a mom?  I can say with certainty that there is less time available for exercise.  When I start residency, there may well be no time.  So yes, there are situations in which a person really may be justified in saying that they have no time for exercise.   I also have more empathy for caregivers of all kinds, because DAMN it is hard to take care of another person 24 hours a day.

I will say that being a mom-med student made things harder in another somewhat unexpected way: After having a baby, I felt like in many ways I was in a similar place in life to some residents and attendings who also had young children.  However, even if I had never worked with them in the hospital, and the only capacity they knew me in was at my child's daycare (for instance), when they would find out I was a medical student, they would treat me like a medical student and not as a fellow-parent.  I found this infuriating, and incredibly isolating.  Perhaps I should have expected this, given the medical hierarchy, but it was sad to me that this was an issue with many of the physician-mothers/fathers I interacted with on a regular basis.  We doctors have a long way to go in supporting one another.