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.

Ilia Tove Scholtens

February 26 at 1:22 AM

7 lbs 8 oz

More here.

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.

Number four

The immediate, unmistakable second pink line on the test laid on the bathroom counter - oh, the power of that pink line. The possibility that it stands for, the hope for a healthy pregnancy and a perfect newborn and another loved child. One slim line that releases a cascade of happy plans . . .

Continue reading.

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.

Testing Flickr's 'Blog this' feature

Leif's scowls make me laugh every time because they require a concerted effort on his part. He carefully arranges his face and announces: "I'm MAD at you!" In this case it was time to head home after picking wild blueberries on Mt. Seymour in the evening.

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.

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.)

Devils are not real

I took inventory of Saskia's beliefs recently. I asked her to answer 'real' or 'not real' to various characters and she enthusiastically complied.

"Santa?" I suggested.

"Not real!" Said with seven-year-old pride.

"Easter bunny?"

"Not real!"

"Jesus?" 

"Real."

"Tooth fairy?" 

"Not real." (A surprise to me, this was followed by a brief discussion to identify my underminer. Pete.)

"Monsters?"

"Not real."

"Giant whales in the sea?" 

"Real." (What about dolphins, interjected Leif. Are they real?)

"Fairies?" 

"Not real." Said regretfully.

"Angels?" 

"Real." In a soft voice, utterly convinced.

"Devils?" 

"Not real." Said with equal conviction, laughing at the ridiculousness of the idea. "Let's do more!" she urged.

But I was too moved by the last two answers to continue.

A walk to the village for Honey's donuts

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.)

California 2009

We're in California (again). I wore shorts today, the warm air washing my bare legs like bathwater. My suitcase is full of books and Internet access is spotty. The cherry trees behind the cabin are in blossom and vibrating with honeybees and I saw a hummingbird as fat as a sparrow this morning. I slapped sunscreen onto three sets of lean little legs and the kids wheeled around on their scooters in the lane for hours. We keep setting out bowls of giant strawberries.

I feel like I have been bounced out of a rut I didn't even know I was in.

In love, age seven

Saskia and I are alone in the van on our way home from school, winding along Dollarton Highway in the slanting afternoon sun. She's in the back seat, quietly looking out the window, when her voice floats over to me: "Can little kids get married?" She asks with sudden great interest, like she can't believe the idea never occurred to her before.

"No."

"Oh." She digests this. She doesn't necessarily sound disappointed.

"Did someone tell you they can?"

"Colin did."

I know who Colin is. He has a sweet round face, brown eyes and hair, reminds me of a bear cub. I had watched him interact with Saskia the other day after school. He hovered around her with obvious adoration. At one point as she brushed by he reached out to play with the bunny tag swinging from her backpack. He looked totally smitten.

"He wants to marry me. In Grade 1 he really liked me. Now in Grade 2, he says he's in love with me." Her voice changes when she says in love, the words weighted with respect.

"That's nice, to have a friend that likes you so much."

She corrects me: "Loves me so much. I'm actually in love with him, too. That doesn't happen every day, does it, that two little kids are in love with each other?"

For once I am completely at a loss as to how to answer.

I know that's she's asking innocently, that a classmate with an older sibling probably introduced the concept. But I don't find anything cute or amusing about children adopting those ideas. I'm always surprised when other mothers chuckle and tell me what a flirt their kindergartner is, or tease their elementary school-aged son about girlfriends. I think friendships between young boys and girls should be considered completely natural. When they're treated as remarkable, I feel that the idea being instilled is that matching up with a member of the opposite sex is the first priority in life, to be pursued right out of the starting gate. That disturbs me. Falling in and out of love (and being consumed by it) is going to happen eventually anyway - why encourage it prematurely at age seven?

On the other hand, I don't want to dismiss her feelings, either. I remember my own intense crushes in elementary school, and they were impervious to other people's validation of them. (There was Chris, who had the affections of every girl in the class, in Grade 3; and Dino, who was a swimmer and reportedly shaved his legs, in Grade 4.)  I wouldn't have dreamed of telling my mother about them, though.

I don't feel prepared for this conversation; I'm unsure of my stance and whether there's even any real importance to the issue. I give Saskia an unsophisticated answer, fumbling, trying to affirm her affection for her friend while dismantling any romantic constructs, steering her away from the idea that she is in love without belittling her experience.

She unhesitatingly accepts what I have to say, then conspiratorially offers an anecdote: "Once I kissed a piece of popcorn and gave it to him and do you know what he did with it?"

"What?"

"He ate it."

Decorating with vintage records

I covered one of Saskia's bedroom walls with vintage record covers.

Collected one or two at a time over a year of thrifting, they cost 25 to 50 cents apiece. Most of them are from the 1950's and 60's. The art on some of these is quite wonderful, and I'd admired them for years but couldn't think of a use that would justify relaxing my efforts to stem the flow of goods coming through the front door.

I keep getting asked how I mounted these to the wall. I drove a nail through each one. All those years of renting as a student, where pounding holes in walls was expressly forbidden, make pock-marking my own walls that much more satisfying.

Now I have a drawer of LPs that I'm sure Saskia would enjoy, but no record player. I don't want a 70's one with giant speakers, but I don't want one that's meant to hook up to a laptop, either. Sony makes this attractive option, but spending $90+ US for a machine to play these two-bit records seems a little self-defeating.

So, another corner of Saskia's room done, another one with which we're equally happy. Really, I should be focusing on the adult living spaces: removing wood paneling, getting some hardwood floors installed, finding a couch. But somehow that feels so much more like work.

Striped

The Morehouse striped vest is off the needles.

This isn't a Sunday-best vest. It's meant to be worn Deep Cove-style, with rolled up sleeves, shirt untucked, ferns and pine needles snagged onto the back. When I knit something for a four-year-old, I fully expect it to be rolled around in.

It does work just as well worn reading Beatrix Potter in front of the fire.

The vest was a beginner-level project, knit with undyed Morehouse merino 2-ply in brown heather and soft white on 3.25 mm needles. The yarn was coarser than what I'm used to (but not itchy), and the needles smaller, and I enjoyed the change.

I've recently joined Ravelry, the online knit (and crochet) community, which allows you to organize your knitting projects, yarn stash and needles, and provides an extensive catalogue of projects shared by others. You have to apply to be invited to join, but I think that's just a manoeuvre to inflate members' sense of accomplishment and belonging. It's not like you have to mail them a swatch.

I'm feeling undecided about what to tackle next. A stuffed turtle? Some Elizabeth Zimmermann?

Or call it a season? I've been back to gardening already, we're planning our annual March-break California road trip and it feels like we're barreling towards spring.

A waterbed covered with flannel

I just came across the most accurate description of the postpartum belly I've ever read, and it wasn't in a medical text. Perhaps you should read this only if you've had a child; it's a bit much for the uninitiated.

People kept trying to prepare me for how soft and mushy my stomach would be after I gave birth, but I secretly thought, Not this old buckerina. I think most people undergoing chemo secretly believe they won't lose their hair.

Oh, but my stomach, she is like a waterbed covered with flannel now. When I lie on my side in bed, my stomach lies politely beside me, like a puppy.

- from Anne Lamott's Operating Instructions: A Journal of My Son's First Year