The Balancing Act

**I brake for Saturday morning donut runs.**

You can get sick of anything after eating it enough. And as much as I loved the veggie burgers sold at the hospital I trained at, eating them every 4th night pretty well destroyed their appeal. Only one thing made them bearable: the company I kept while eating them. Rockstar came to the hospital every 4th night for my entire intern year. Whether I had a 10 or a 30 minute break, those stolen moments scarfing down a tired sandwich, kept me going.

I’ve never taken my husband’s support of my career for granted. In fact, it still strikes me as this incredible thing: that he bought so fully into a dream that wasn’t his own.

When I meet young couples, one of whom is starting down the medical training road, it’s usually the partner who I feel sorry for. Because I know how this road demands everything a family has to give, and that’s harder for the person who didn’t choose it. I’ve seen relationships fall apart when the spouse wasn’t ‘all in’ and felt like it was all too much.

Last week I wrote the post below on Interruption. I talked about how the weight and joy of the white coat is that when it’s on, it’s really not about me.


**Spring is here-happy, happy day.**

Reader, Aurora, who is starting out her journey in medicine, made the following comment:

“The thing I struggle with is this: How do I be okay with taking that time away from my son and husband and (essentially) acknowledge, "It's not about me... OR you." It's so hard sacrificing family time for patients on my child's behalf. I see so many children of physicians resent the time their dad missed a baseball game to repair an aortic aneurism or counsel a patient. Where do you draw the line and how do you reconcile that boundary, emotionally?”

These are great and important questions to consider.

The tricky thing about medicine is that for better or worse, it does require a relinquishing of self that not many other professional training roads do. It’s not that other training roads aren’t as or more rigorous than medicine, but medicine is one of the most iconic service professions. There are expectations that go along with that, and they live alongside the reality that lives are always hanging in the balance.

So, what is the trick to balancing family and medicine? I’ve seen it done a lot of different ways. Over the next week or so, I’ll be stopping in to share what I’ve learned along the way. I'll start with medical school and work my way up to attending-hood (what, you didn't know that was a word?)

Here’s one before I hit the sack:

*During those first two years of medical school, be physically present as much as you can. With so much lecture material available in notesets or in textbooks, many students in my med school class skipped some lectures in lieu of reading the material on their own. Depending on what kind of learner you are, this can be an effective use of time, and free up more time with your family. The last two years of med school don’t allow a lot of flexibility in terms of location and schedule, so use that flexibility while you have it. Of course the ideal is to be home physically and mentally. But your physical presence still matters, even when your mind is on pharmacology. Some people can’t study well at home, and I get that. Sometimes my friends and I would study at Barnes and Nobles on Friday nights. We knew it wasn’t as good as library time, but we were getting through some material and also preserving our sanity by feeling like we weren’t locked away at school all the time on weekends. Especially if you have kids, think of studying at home in the same way. Not perfect, but yielding important benefits.



**Shoot for the stars, baby. And when you fall short, that's okay too.**

Interruption

**Target is dangerous. I saw a heart shaped miniature pie-press,and wham-o! How could I not have a Valentine's tea party for Tiny and a couple of her friends?**

Among the many things that can interrupt the mojo of an afternoon of patient care, are fire alarms.

Yep, fire alarms.

Take this week, for example. My patient was all set up for her IUD placement, and my nurse and I were at the ready. I sat down to begin, when I heard a strange buzzing.

"What's that sound?" I asked my nurse.

"I'm not sure--should I check?"

"Yes, just in case it's a fire alarm."



**I think Rockstar's alarm bells go off everytime I walk by the dollar bins. Because suddenly I'm in a haze of, 'it's pink and miniature and ONLY A DOLLAR!' Seriously, though, thanks for the cute straws and party bags, Target.**


Well, whaddya know, it was! My patient was gracious about her sudden, albeit temporary, reprieve from the scheduled procedure. My nurse and I waited outside for her to get dressed. Several people passed us while we waited, and advised us to get a move on. We advised them that it seemed in poor taste to leave without our customer.

We walked out into the (mercifully mild) weather, and observed an enormous group of people--staff, doctors, nurses, patient's--standing together in the parking lot. Commenting on the cold, checking smart phones, wondering if this was 'real'.

I wondered how I was going to come back from what ultimately ended up being an almost 40 minute evacuation (!!!).

Miraculously, things went incredibly smooth once we got back into our office. Patients were understanding, visits were fairly straightforward, and a normal departure time looked not at all unlikely.

My last patient was a nice woman who I've been taking care of for a while. In the course of our conversation, she mentioned some chest pain that she'd had recently. She seemed almost embarrassed to bring it up. "I know I shouldn't even say that word in a doctor's office," she said.


**Say the word 'jewlerybox' to four little girls, and you've suddenly got their undivided attention! Again, thank you to the dollar bins.**


After discussing it, I knew we needed to do an EKG. Since we were down in a satellite office that afternoon, it would take the nurse some additional time to get the machine brought over and set-up. I mentioned to the patient that I wanted to proceed with doing the EKG and she said, 'But you guys have families that you need to get home to! Are you sure?'

I laughed it off and said, "I promise you that I don't base my clinical decision making on what time I want to leave the office.

I left the room and waited for the EKG to be done, feeling grateful for my nurse. She didn't even bat an eye at the delay.

Here's the thing: I'm not going to lie and tell you that there was no passing disappointment when I realized that my family would be waiting an extra half hour for my arrival home.

But the weight and joy of this white coat is that when it's on, it's just really not about me.

And that is the thing that ultimately keeps me going. Because when it's the right cause, giving more of yourself than you sometimes want to give means pushing through to something better. It means fighting fatigue and being flexible to land in that place of satisfied exhaustion that fills you up and lets you know that maybe your efforts are adding up to something bigger after all.


**My girl loves nothing better than to take pieces of this, and bits of that, and turn it into something bigger. In fact, I think she could do it all day long.**

Lessons In Doctoring

{We took the kids to this most amazing amusement park called 'Dutch Wonderland' a few weeks ago. Imagine a clean amusement park geared entirely toward the 3-6 set. Imagine that there are no lines. Imagine no rowdy teenagers walking around and imagine your 3 yo being able to ride 90% of the ride. Sound like heaven? Pretty much. All the ensuing pictures are from there.}


**Tiny was a big fan of the face painting booth. And the lipstick (ahem) that the girl added at the end."

Lonely. Defeated.

Those would be the words that probably best captured my mood in the first few months of medical school. I was an English Major from California suddenly living by herself in a basement apartment back east, surrounded by science textbooks. Fish out of water, much? Being at the beginning of that medical road was probably the hardest for me. Yes, I still had lots of energy and none of the fatigue that can come later, but I could also not conceive of such a path ever ending. It looked interminable from where I stood.



**Luckily our Lil' Drummer did not mind the interminable merry go round rides we took him on.**

And it wasn’t that I didn’t have amazing people around me. My sister lived a short drive away, and I met some of my favorite women in the entire world the first week I moved out.

So why was I lonely? I think I felt lonely in the work I had to do. You know when you’re overwhelmed by a task, but you know it’s no one else’s but yours? Yeah, that’s how I felt.



**Being pronounced 'Lady Tiny'...now that's a lot of responsibility.**

Then soon after school began, I flew out to CA to attend the weekend wedding of a cousin, which was delightful. I didn’t want to go back and face the grind of school again. But I had no choice but to get back on that plane. If only I had known that I had the beginnings of a cold! The congestion hadn’t been enough to catch my attention until I was 30,000 feet above ground, and then—yowza! My ears were in a world of hurt. Even when I landed, my ears wouldn’t pop and the pain wouldn’t stop.

I slept at my sister’s because I was a little freaked out by the pain. Well, I didn’t sleep much.


**A little freaked out by his first ride EVER.**


**Tiny got freaked out on this ride since we were spinning out of control. The ride attendant, who introduced herself beforehand, didn't really play along when Rockstar asked her to reassure Tiny that the ride wouldn't be so bad. Tiny started protesting and calling, "Sarah, Sarah! Stop the ride!" once the whirling madness began.**

Finally I dragged myself into the student health clinic, hoping they would be able to offer some kind of treatment.

I sat on the crinkly white exam table paper with all my pain and frustration buzzing just below the surface.

A female doctor, probably in her 30’s and brunette, entered the room. She sat down and asked me what had brought me in. I told her my story, and then she noticed on my chart that I was a medical student.




**Mama's Boy**


“Oh! I see that you are a medical student?”
“Yeah.”
She paused, and I think she could see through the fragile shell holding myself together.
“How’s that going?”

The shell cracked and a tear slipped out. Then the crack was a chasm, and I was crying visibly.

“Not very good,” I said. “I’m tired and lonely and it feels like too much.”
She put her hand on my knee and listened.



**Sometimes life pushes us out of our comfort zones. Exhibit A: Tiny's first rollercoaster.**

“I remember that, too,” she said. “The beginning is hard. But you can do this. It will go faster than you think.” I can’t remember what else she said, but I remember how she said it.

So kind.

We didn’t talk more than a few minutes. She gave me a prescription, and I stood up to leave.

The feeling I walked away with has left an indelible mark on my mind and my practice as a physician:

My ears still hurt, but I felt healed.

This and That

**Drummer appears to have his dad's percussion gene. Hence why I call him Drummer. If he has maracas, he will walk around shaking them until the cows come home. Luckily my in-laws stock all sorts of instruments to feed his fascination.**

*This week we're having an ice cream social to welcome our new class of interns. We'll feed them yummy treats, give them a pep talk,and then proceed to take them over body and soul come July 1st. Mwahahahaha... I kid! Sort of. ;) If you want to read what I wrote right before starting my intern year, lo these many years ago, go here.

I tell you what, I kind of get palpitations just thinking about it.


**First Harvest! Tomatoes taste better when you grow them. Or maybe it's my imagination.**

*Have you heard about this? I think it's a good thing that they are trying to attach some reality to the habit of smoking habits by posting these graphic pictures on tobacco prodcuts. Some people fear that smokers will get annoyed at a perceived government intervention, and stubbornly keep smoking. Perhaps. But I think if it can give some of the younger smokers pause--if it can make them contemplate consequences they'd rather ignore, then I say kudos. It's worth a shot.


**My in-laws also stock their own costume collection and this one has been deemed 'sleeping beauty'. Boy does she put on an amazing show in their living room. Dancing faster than a speeding bullet!**



**She signs autographs. And it is serious business.**

*That P.9-0.X is a real doozy, eh? I tell my patients that they need to be in an exercise routine, so at some point I needed to start taking my own advice. I mean, I've always been intermittently active, but the routine? Therein lies my struggle. So I started attending this weekly boot camp class a while back, which was fun. Then our instructor moved, so another friend offered to lead us in P.9-0.X. Have you tried this? Exceptionally effective stuff, but I tell you what, I busted my shoulder the first day. Which means exercise is bad for you I am now under my own doctor's orders to rest up. I think that's one prescription I can most definitely follow through on. :)

(I intentionally mistyped the name of the exercise program to avoid it coming up in what I'm guessing is a frequent google search!)

*This year, So You Think You Can Dance is especially awesome. I love that show.

Five Favorites

1)Doctor-Patient Relationships

**Tiny learns the ins and outs of a stethoscope.**

This week I had to say goodbye to a family I've been taking care of for a while. They are moving up north, and that means I no longer get to see their boys grow up.

It kind of broke my heart. But I'm okay with that because it means these relationships really matter.

I think it's fabulous that family practice allows me to really be a part of people's stories. I love that I meet them and their children and their friends. I love hearing about their lives.

These are the reasons I chose primary care, when it was not the hip thing to choose at my east coast med school. I knew that I wanted to be on the frontlines of medicine, and I knew that I wanted to build relationships.

It's good to see that come to fruition.

2)3 year old dressing


This deserves a post of its own, which I will get to sometime soon. But I think we should all just throw caution to the wind this weekend and mix patterns and colors like we just don't care. And maybe put our shirts on backwards.

3)Curbside Shopping



I bought this vanity a few nights ago after seeing it up for sale on a neighbors lawn (priced all cheapity cheap given the damage). I drove by it on the way to work and saw the potential immediately. I convinced Rockstar to walk up there with me and the kids after dinner, and he didn't put up a fuss when I decided to make an offer on what will surely require a bit of elbow grease on my(his) part.
He's learned that even though there is no obvious place for this piece in our home right now, I have a deep 'where there's a will there's a way' streak in me. Especially when it comes to inexpensive antique furniture. Which is probably not what my mother had in mind when she used to drill this phrase into my head.


**It's the detailing I can't get over.**

4)Water.

Water makes kids happy. The end.





5)Taking care of little sprouts is the best. No?



Happy Weekend!

Doctor Thoughts and This and That

One of my good friends told me that one of the things she most appreciates about her pediatrician is that she makes her feel like she's doing a good job. "Every time I leave, I feel like she has affirmed me as a mom." I loved that. I wanted to give that gift to my patients. I hope I always have, but it's something I've been more conscious of since she said that. This last week I've had a bunch of families coming in for their kids' physicals. It's really so much fun. I love seeing the sibling interaction and talking to the moms about their concerns and their successes. Frequently I'll pick up some new parenting tip from the moms. I admire the families I take care of for so many reasons and I'm grateful to get to be part of their lives. And, hopefully, I communicate that so that they leave my office feeling like they are capable.

I have my own story to share sometime about what I appreciated as a patient, but I'd love to hear yours. What does your doctor do that you appreciate?

**This is the recipe for the black bean burger that my friend Kyra sent:

"THE BEST BLACK BEAN BURGERS!
what you need:

•1 1/2 cups cooked black beans (a 15 oz. can very well drained)
•1 14.5 oz can diced tomatoes (very well drained, and there is a typo in the magazine, it calls for a 4.5 oz can, but that is incorrect)
•1 cup fresh cilantro or parsley (we used cilantro)
•1 teaspoon ground cumin
•1 clove garlic
•2 green onions
•2/3 cup shredded carrots
•1 3/4 cup rolled oats

Put all these ingredients in the food processor and turned it on. It helps if you pre-chop the veggies, smash the garlic, and really drain the tomatoes. Use a big dough scoop to make 8 patties, and press them flat on the tray. Bake on parchment paper or a silpat at 400 degrees for 20 minutes, carefully turn them over and bake another 15 minutes. Eat right away or let cool and freeze.

Eat on a whole wheat bun with lettuce and a little chipotle sauce, which is chipotle puree mixed with either ketchup, sour cream, or mayonnaise."

My notes: I used the cilantro, which I thought was great. Chipotle puree eluded me, so I went with a sour cream/salsa mix and avocado slices as a topper. Delicious. Also, if you have a convection oven like me, you may only need to cook them for twenty minutes total. Enjoy!

*That is how we spent last weekend's rainy day. An extended tea party at my in-laws. Today was similar-- tea parties, extended naps, and a little spring cleaning.



*This is a new discovery--she'll eat hardboiled eggs! Hooray for the egg-dyeing that led to this discovery.



*That (pulling the CD's off the shelf) is one of his favorite activities. That and climbing things. Heaven help us.



*This is where we were a year ago. How was that seriously a whole year ago, and yet, how was Drummer not there? Know what I mean?


**image by the amazing Nancy**


*That is my little girl last Easter.



She has grown up so much. I love this holiday. I love all of its fun traditions--eggs, Easter Bunnies, and candy. Most of all, I love the chance to celebrate that He is Risen.

Happy Easter Weekend!

The Saga Continues

After my aforementioned day in the ER, we were looking forward to a productive Saturday out in nice weather.

Again the universe said: Psych!

We put Lil’ Drummer (who had been in completely good health—no cold symptoms or what not) down for his morning nap, and anticipated that when he woke up, we’d hit the road to run a long list of errands. He woke up early from his nap, but didn’t seem too out of sorts initially. Rockstar took him downstairs so I could finish getting ready, but I soon heard him crying. A lot.


**back to his chill self**


I walked downstairs to see what was going on. Initially, I was annoyed, thinking, ‘why aren’t you helping this poor kid who is obviously in distress?’ Except when I got down there, I saw that Rockstar was holding Lil’ Drummer, trying to give him a pacifier, but nothing doing.

Huh. Drummer is a pretty chill little guy. He gets fussy at all the normal baby things (Hungry! Tired! Dirty diaper!), but otherwise, can generally be talked out of crying spells. So it struck me as odd right away. I reached for him, assuming the crying would cease as soon as he was wrapped in mama’s arms. But, you know, it didn’t.

I should note: There is a difference between normal baby crying and panicked, red in the face, high-pitched screaming. This was the latter.

And nothing made it go away. We tried getting him in his carseat and on the road, because he generally responds well to being on the go. Nope.


**on the go**


We tried walking him outside in the wind. It helped only a little.

We tried feeding him—he wouldn’t have any of it. He wouldn’t nurse, he wouldn’t eat, he wouldn’t take his paci.

We tried changing him, rocking him, distracting him. We tried Motrin. We tried Tylenol. N.O.T.H.I.N.G. worked. After my own ordeal the day before, my nerves were already shot. So Rockstar and I were on edge. There was no way on God’s green earth that I was going back to the ER unless I really had to, but I was starting to get nervous.

Being a mom and doctor can be a double edged sword when it comes to taking care of your own kids. Even though I think on the whole it is helpful, there are times when your mind takes you to the worst case scenario, because you’ve seen it. So my mind was thinking of intussuception (an uncommon, but serious bowel problem that inconsolable crying can be a sign of), since he’d demonstrated no other sick symptoms that would indicate an ear infection, hand/foot/mouth, or some other virus. And at a certain point, you want a third party to come in and look at the situation, since your intense motherly concern can make it hard to be objective.

So, we scheduled a visit with the pediatrician, who mercifully still had Saturday afternoon appointments available.


**this week finally brought a chance to go exploring**

We loaded both kids in the car (because neither of us wanted to go it alone) and made our way there.

Within 10 minutes of walking the hallways outside the pediatrician’s office, Drummer’s hours of crying had softened into whimpers, and then into silence. Oh, blessed silence.

By the time we saw the doctor, he had decided he was willing to eat, and looked the part of a normal, healthy baby. Do you ever feel going to the doctor is like taking your car to the mechanic? The car never makes that weird sound you ‘swear it’s been making’ when the professional is listening.

I told the doc his symptoms, and he agreed that intussuception had to be considered, but set about examining him for other problems.

His exam was entirely normal. He advised me to head to the ER if he had 2 or more uncontrolled crying episodes.

We have both been fine ever since.

Can I just say: Dude, we are so over the mystery syndromes round these parts.


**enjoying open spaces**


p.s. A few people have asked if I think mine and drummer’s episodes were related. The timing was awfully strange, but there were no symptoms to indicate either of us had anything infectious. I’m still thinking mine might have been related to some type of small abdominal wall hernia that went back into place before it was imaged, and I don’t know what was going on with my little man.

I guess this drives home the point that medicine is not an exact science. There will be questions that we will never be able to answer, despite our best efforts. Frustrating and Humbling? You better believe it. But I'm learning that life is more about the process than the definitive solutions and answers we crave.