FreshMD

Feelings of loss post-partum

When Ilia was a few weeks old, Pete asked, and said it so casually from the couch where he was reading after dinner, "Do you miss our old life?" . . . continued.

Ten guidelines for medicine-life balance

Right now, this month, seven years out of residency with a part-time position at the refugee clinic and three and three-quarters children, I have work-life balance. It's somewhat precarious, something that could be toppled by illness or an unbearable colleague or a newborn, but I would rate my current satisfaction with both career and home life as high. Here are some philosophical and practical guidelines that I follow:

1. Accept that you can't have it all - at least not at once - but you can have a life that is rich and full and satisfying. I watch resignedly as other (childless) physicians at my clinic leave to spend months working in Afghanistan and Peru. I'm the mother that arrives late to the preschool Christmas potluck and sets a box of mandarin oranges next to the homemade cheesy noodle casseroles. My son's school uniform pants are embarrassingly short and I couldn't make a recent cross-cultural mental health conference because I'm home with my daughter on Thursdays. But I have kind, secure children and what is arguably the most delightful, rewarding patient population in the city. It's enough.

Continue reading at Mothers in Medicine.

I don't look twenty-two anymore

And I'm fine with that (@ Mothers in Medicine).

What can still make a physician-mother squeamish

New post up at Mothers in Medicine.

A day in the life

The topic of the week at Mothers in Medicine is "A Day in the Life." Check out the typical day of a neurologist, pediatrician and internist. I describe a typical Tuesday at the refugee clinic here.

The antidote: knitting

Post up at Mothers in Medicine on why I consider knitting the perfect antidote to medicine and parenting.

I put an embryo on a daycare waitlist

September 2001

One year and three months into a two-year residency, I give birth to my daughter. I am eligible for one year of maternity leave, and have every intention of staying home with my sweet, big-eyed Saskia for all fifty-two weeks. Pete and I haven't yet decided what we'll do for childcare when the year is up, but daycare isn't even on the table. I grew up understanding that daycare was for the unfortunate children of selfish mothers. It was fact, just as neighbours who mowed their lawns on Sundays could not be Christians.

January 2002

I sit at the desk in our loft, looking at a list of home daycares. The nine remaining months of residency loom over my days with my infant daughter. I have an irrational fear that I will have a series of consecutive pregnancies - defying all contraceptive measures - causing a perma-maternity leave and precluding any possibility of ever finishing residency. I am desperate to be done with it . . .

Post continued here. The topic today at Mothers in Medicine is childcare, where fifteen of us weigh in with our experiences.

Looming deadline for professional success: age 40?

The effective, moving, vitalizing work of the world is done between the ages of twenty-five and forty.

- William Osler (1849-1919), renowned Canadian physician

I turned thirty-five last month, and what struck me most was how odd it is that it's been thirteen years since I was twenty-two. But apparently what I should have been impressed by is the five short years remaining in which to make a significant professional contribution to the world. I find this idea disconcerting, as I'm waist-deep in raising kids and was banking on my next decade to make some strides career-wise.

More here at Mothers in Medicine.

Dandelion poetry

Thank you for all your kind comments and well wishes on the last post. As suggested, I plan to link to my Mothers in Medicine posts from here. There's a new one up today.

Finished

When I began blogging, a family member unfamiliar with blogs looked over this site and said politely, "It looks nice. Is it almost finished?" 

Well, now it is. 

I feel hamstrung by the mix of personal and professional anecdotes under my real name in the face of increasing readership. I find myself censoring and second-guessing myself and that really dilutes the pleasure of blogging.

I started this blog for the satisfaction of crafting bits of my chaotic days at home and work into a tidy package. But now my domestic and clinical days have settled into a relatively unruffled routine and I'm eager to pursue other projects. Any creative energy (and time) not exhausted by children or patients is in short supply, not enough to slather over multiple projects.

And so I need to absolve myself of this blog. I'm not sure if I'm euthanizing it or inducing an indefinite coma. The site will remain up but expect this post to greet you for the foreseeable future.

I'll still be active at Mothers in Medicine, Twitter and Flickr. 

Thank you to my little band of readers, especially those who commented or emailed over the last year and a half.

Baby names

I have a post up at Mothers in Medicine on the medical implications of baby names, including my own close call with the name Claudia.

(If you've been reading this blog since the beginning, you might remember I did another post on the topic way back here.)

The R-word

There's been a move afoot recently to stamp out the R-word. 

While I agree that the use of retarded as a derogatory term is offensive, I can't help wondering: Why aren't paraplegics protesting the slang use of lame? Why aren't families of schizophrenics fighting the word psycho? 

There are scores of medical words indicating impairment that are used disparagingly in every day speech: Dumb. Idiot. Blind. Imbecile. Moron. 

Some insults are used with no recognition of their medical origins. Cretin is someone who suffers from congenital hypothyroidism, but I've never heard the word used in that context outside of medical school.

I suppose the degree of offensiveness of these words depends on where your sensitivities lie. I cringe when people bandy about terms like brain-dead and on crack; light references to head trauma and addiction bother me as much as the slang use of retarded.

 

I don't oppose efforts to eliminate the R-word. But to be consistent, better ban the L-word, too. And the D-word, the I-word . . .

Sanatorium

One of my favourite photos in the album from my grandmother is this one, of her brother in a sanatorium in Harderwijk, the Netherlands in the 40's: 

Sanatorium sounds psychiatric, suggesting a place where one's sanity is restored, but it's an institution for medically supervised recuperation from disease, usually tuberculosis. From a medical and a literary perspective, I was admittedly pleased to discover that a relative had suffered from consumption.

 

I love the button-up pyjamas, the drape of the bed sheets, the sun behind the curtains in the high windows and - most of all - the perplexing X where Oma marked her brother in ballpoint pen.

My aptitude for family medicine: poor, apparently

I did the University of Virginia medical specialty aptitude test purely for sport recently and was startled to learn that of 36 medical specialties, the one I am least suited for is family medicine. 

I'm not surprised that family medicine did not rank first. I chose it only partially because of any natural inclination toward it, and mostly because the training and practice of it meshed best with other priorities in my life, particularly raising a family. What did take me aback was that it occupied the very last spot on the list.

Pathology and radiology ranked at the top. 

From time to time I flirt with the idea of returning to residency, but what it comes down to is that I would rank my current job satisfaction as a family physician at a 9/10. Is a chance at boosting that to a perfect score worth three more years of residency, a massive reorganization of family roles, a significant reduction in my time spent with the kids and a hefty kick in the pocketbook? I don't know.

William Maxwell, fiction editor of the New Yorker from 1936 to 1975, said upon retirement: "For nearly forty years I have shaved with pleasure in the thought that I was about to come to this job." How I love that quote. What a gift, such perfect happiness with one's work. 

Of course, while he was shaving his wife Emmy was likely frying up the breakfast bacon, readying their daughters for school, preparing for a day of housework and granting him the enviable ability to be single-minded. 

That is what I find most difficult about mixing medicine and motherhood: the diffusion of focus. 

My work in refugee medicine is profoundly rewarding; raising three little ones even more so. The two have proven to be compatible. And yet at some point the efforts put into one require sacrifices made of the other. There simply are not enough hours in the day for me to invest what I wish I could into both spheres. I have erred on the side of mothering, and while I do good work at the clinic, my career trajectory has been modest.

I say this cheerfully. So far, I don't regret any decisions I've made. And every day presents an opportunity for new and different choices. Maybe one day, when the kids are a little older, I'll alter my career track or return to residency.

But for now, and maybe forever, a 9/10 is good enough.

(Cross-posted at Mothers in Medicine.)

The Clinic

The March issue of Doctor's Review alerted me to The Clinic, a medically-themed restaurant and club in Singapore.

* Photos by Yueh-Hua on Flickr, used under Creative Commons license

Patrons sit at operating tables in gold-plated wheelchairs, eat from stainless steel kidney basins and have their drinks hung from IV poles. Operating room lights enhance the ambience.

* Photo by projectnada on Flickr, used under Creative Commons license

* Photo from Max magazine

Apparently the food is fantastic. But what I find most appealing is that medically graphic table conversation would actually be appropriate here: 

So I had this patient today with a massive abscess, and I incised it and it must have taken me ten minutes to drain all the purulent discharge from it, it just kept coming. (Short pause as she takes another bite, her fork ringing against the steel bowl.) And then this afternoon a guy came in with an upper GI bleed and as I was taking the history he started vomiting blood. It was actually splashing on the floor . . . 

* Photo (L) from Travel + Leisure; Photo (R) from Designboom

I wonder if they ever host medical conferences?

Medically relevant prizes for pediatric patients

You know how most doctor's offices hand out Dora or Bob the Builder stickers to kids who take their vaccinations like little soldiers? 

I've found something more appropriate:

Available here at Supergirl Stickers Etsy shop.

And for the real trouper, a set of magnets:

* photos from the Supergirl Stickers Etsy shop site

I really should stockpile some good prizes. Do you know what my pediatric patients currently get at the end of the visit? A tongue depressor. Sometimes when I'm feeling generous I draw a kitty face on it.

Fired

I have a post up at Mothers in Medicine on the futility of rushing kids, a desperate white lie to hurry Leif along and his interpretation of being fired.

Tights

Instructing a patient on how to undress for a pelvic exam the other day, I told her, "Your shoes and underwear need to come off. You can remove your skirt, or lift it above your waist." Her English was minimal, and we didn't have an interpreter, but I was confident we could get by with simple instructions.

As she pulled up the hem of her dress to remove her shoes, I caught a glimpse of brown, fuzzy tights. "You'll need to remove your tights, too," I added.

She looked at me, uncomprehending, and continued to undress.

I noticed later, to my great embarrassment, that she hadn't been wearing tights. The skin on her legs was such a rich homogeneous colour, covered so evenly with down, that I had mistaken it for fabric.

Why infectious disease docs are so likeable, Exhibit A

This is the unedited first paragraph of an infectious disease specialist's response to an email inquiry from our clinic regarding screening for schistosomiasis, a parasitic tropical disease that typically presents with abdominal pain and diarrhea:

Schistosomiasis is so COOL.   I love those little fellows.  They get through your skin, go on safari through your tissues, and then settle down to raise a family, letting their eggs cruise out through the intestinal wall or bladder wall to start life anew : )

I'll bet you've never seen an emoticon used in that context.

Every infectious disease physician and microbiologist I've encountered is that enthusiastic. At the ID conference I attended last fall, every presenter spoke with actual affection for his favourite microbe, announcing that he could talk about the subject all day long and sighing when his time was up.

Exhibit B would be their penchant for bow ties.

Obama

A New Mexican medical student shadowed me the other day. He was part of a group of American medical students learning about Canada's health care system.

I always enjoy having students - their youth and enthusiasm is refreshing - and this one was no exception. He had to duck out early to meet up with his group, and as he thanked me for my teaching he rummaged in his backpack and pulled out a pink envelope. It was deliciously bulky, and I set it aside to open after I had finished seeing patients.

At lunch I pulled out the card, and this fell out:

This amused me for the rest of the afternoon.

I am the least likely person to wear a button of any sort, especially a political one. Especially one touting the politics of another country. Did he assume I would be an Obama supporter because I'm Canadian and ergo a liberal? Because I'm a physician? Had the Republicans won, was there any chance that a medical student would have given me a McCain pin? I imagined how my colleague would have responded had a student given him a W pin four years ago. It would have been evaluation suicide.

I showed my gift to the front staff, who all admired it and hinted that they would like to have it. I declined. It was a thoughtful and unexpected gift, and the optimism of the medical student, the gesture and the prevailing mood of post-inauguration USA all came together for me in this small metal square.

So I'll be keeping it. But I'm as likely to wear it as a New Mexican physician would be to wear a Stephen Harper button.