Category: medicine

End of an era

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I feel a huge sense of relief and a ton of positivity this week. Where do I even start?

Obviously there was the inauguration. I have never been a political junkie. My parents came from a country where there was a military coup during their lifetime, all books with dissenting political ideas were burned at their universities, and friends and acquaintances were taken from their homes in the middle of the night and murdered for having dissenting political opinions. Because of these reasons, my parents were always largely apolitical. We never put out yard signs, protested as a family, or watched States of the Union, inaugurations, etc. I myself have adopted some of this trepidation around openly expressing political opinions – especially in my role as doctor. We are so divided as a country that it seems so loaded to me to bring up politics or, more commonly, to respond to a patient’s comment on politics. But lately, due largely to the impact of social media, I have begun to wonder how much of my reticence to discuss politics comes from a place of privilege. I’m an immigrant who has been a citizen of this country for decades longer than I’ve lived outside of the country. I’m White passing, gender normative, heterosexual, educated, financially comfortable. So I have been trying to step outside of my comfort zone to be more vocal in order to advocate for others. And also, to be honest, because the events of the past four years have been disturbing beyond words – so, so, so much worse than anything I could have ever envisioned in November of 2016.

But now, there is hope. And yesterday, I sat with my two older kids and replayed some of the performances and speeches from the inauguration. The kids celebrated it at school. And I breathed a sigh of relief that my older children, now 4 and 6, would have memories of a President who is decent, humble, honorable and a good human being.

Second: this is my last week before heading back to work. I have a lot of mixed emotions regarding this. I think: this is the last time I will ever have an infant. The last time I will ever hold someone for every nap during the day. The last time I will ever spend so many hours per day, every day, every week, with one of my children. I feel a sense of nostalgia about this moment, but not necessarily sadness. As my husband likes to joke, we have done this four times – and that’s plenty! I am also looking forward to this next phase of my children growing into adults. I already see changes in my 6 year old – bigger worries, harder questions, the ability to read and digest actual novels (he is currently reading the second Harry Potter book). He is losing some of his child-like innocence.

To be honest, being home with four children 6 and under is a lot. As I always say: being a stay-at-home parent is MUCH harder than being a working parent. Yes, work is demanding. Yes, it adds a full-time job on top of full-time responsibility. But work allows you to tap into the essence of who you are. A lot is lost in motherhood – hobbies, memories of who we were pre-children, meaning outside of these small humans. For me, working is a way to hold onto a crucial component of who I am. I’m able to have adult conversations, use my analytical mind, help others in ways that are tangible, eat lunch, go to the bathroom alone, have uninterrupted thoughts, etc. I’m very much looking forward to that. But, in addition to missing the baby snuggles and extra quality time with my kids, there are two things I will miss dearly: (1) flexibility – the ability to make every last-minute school engagement without thinking about it, the ability to attend to a child’s needs 24/7 with no other obligations, the ability to run an errand for the home every day of the week, the ability to pick the kids up when they are not feeling well without having to cancel clinic, the ability to quarantine for 2 weeks without being disruptive and (2) mental space. I have been thinking about this one a lot. For a variety of reasons, I was feeling pretty burnt out before going on maternity leave. Not working has off-loaded work stress from my life (that sounds pretty obvious but it’s true!). I don’t have to worry about having a difficult conversation with a colleague, feeling disrespected by administrators, challenging patient cases. It’s hard for me to leave work at work – to compartmentalize it – especially when I have the ability to be connected 24/7 and also when I do split my workday to make time for pick-up, kids’ activities, etc. I see sick patients and I worry about how they do, and it is impossible for me to turn that off at 5pm. So I am going to see how to compartmentalize the things that I can – non-clinical work – while also feeling relieved that I have dissociated from the more toxic work environment I was previously in.

Third: I received the second COVID vaccine. I am so so relieved by this. I will, of course, continue to use PPE at work and masks when out in public, but I feel so much better knowing that I will be somewhat protected against COVID, especially when seeing positive patients or those who are being evaluated for active disease. My parents have both received one dose of their respective vaccines (they work in healthcare) and my brother and parents-in-law recently recovered from COVID, so I am hoping this all means that we can have some sort of reunion later this year.

Finally, I have restarted on of my favorite past times: reading. I am on my fifth novel this month and have been working to actively carve out time to read each day. Of course, this will be somewhat compromised when I start working, but I am hoping to keep at least 50% of this reading productivity. Reading brings back such great memories for me of reading during childhood and I think it’s so important for the kids to see me reading as well. It has also provided some much needed escapism during a year that has afforded such few opportunities for activities that remind us of normalcy.

Here’s to the end of one era and the beginning of an even better one.

Vaccinated

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I received my COVID-19 vaccine today. The Pfizer one was offered to me and I took it. I feel a bit like I did after Election Day this year – ready for a big sigh of relief.

I still remember how we stumbled around COVID in the early days of the pandemic at my hospital. We weren’t quite sure what the precautions should be. When my first patient showed up, having just flown in from China, I went into the room alone, wearing an N95 mask and gown. But we still didn’t wear masks or eye protection in the workrooms and all other patient encounters were routine protocol. I remember the first time a COVID test was run on a patient I had seen on the inpatient service. My colleague called her daughter’s school and they asked her to pick her up. I was so worried that I had been exposed and would be exposing my whole family. Fortunately, that patient tested negative. I remember clinics shutting down completely and being converted to video. A few patients still wished to be seen in person and I would go in to see them. I brought my own Lysol wipes from home and wore scrubs every day. Hair up, N95 on, surgical mask over the N95, face shield in place. I would avoid my children when I arrived home and jump straight into the shower. I was so worried that I would contract COVID while pregnant – so worried that I stopped seeing patients at 34 weeks and took a full month of prepartum leave. At the time, all of these precautions seemed temporary and we thought we’d be up and running full throttle by the summer. And yet, here we are 9 months later.

One disclaimer here is that I am primarily an outpatient physician. I see oncology patients and do round regularly in the hospital on our consult patients, but I am not on the front line (emergency room, ICU, COVID units, etc.). I am in complete awe of the physicians, nurses and hospital staff who have been on the front line this entire time. I do not have it in me to do what they did. My patient population is primarily healthy, but there was still so much fear around pre-symptomatic patients coming to clinic, colleagues coming to work before diagnosis, etc.

All this to say that getting this vaccine was a big deal for me. It was a sign of hope – hopefully the beginning of the end. Although I plan to wear PPE the entire time I am at work, I feel reassured that I am less likely to contract COVID if I am exposed. Although we don’t have the data, I am also hoping that this means I am less likely to transmit COVID if exposed (again, this wasn’t studied, so we won’t know for some time). I am still nursing but decided that the risks to my infant of getting COVID were greater than any theoretical risks related to vaccine administration. I hope that by the time the general public has the opportunity to be vaccinated, we have more information to power the decision-making process. I am not the type of person who jumps on the bandwagon for new therapeutics, but as I always tell my patients who are interested in a new therapy or intervention – you have to weigh the risks against the alternative, not the ideal. Do I wish that we were not in the middle of a pandemic that has kept us away from our families for the past 9 months, kept my kids out of school for much of the year, led us all to wear masks and stay 6 feet apart and completely crippled our social interactions? Of course. But the fact of the matter is that we are in the middle of a pandemic and I will be working through it. It made sense to me to add a layer of protection by receiving the vaccine. And hopefully this truly is the beginning of the end and we can start moving towards relative normalcy sometime in 2021.

Merry

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Yesterday, I asked my husband what was on his agenda for work and he responded that it was a “thinking day”. A day to reflect on strategy, innovation, next steps. To be honest, it sounded glorious. A whole day to just think about something unrelated to the home.

Right now, I am enjoying a bit of quiet, thinking time. My oldest three children are with our nanny and my youngest is taking a nap with me, in the carrier. I have decided to return to work next month and am feeling incredibly conflicted about that. On one hand, I really miss working (I’m a physician). I miss my patients, I miss my colleagues, I miss teaching, I miss having adult conversations and I miss being able to THINK – about diagnoses, patient messages, treatment options, research, etc. On the other hand, the flexibility of my maternity leave has been a godsend – especially during this incredibly tumultuous year. In the morning, I don’t have to wake up before the children do to get ready for work. I can let them wake me up, sit with them while I drink my cup of coffee, stay in my pajamas and play. With school closed during this holiday break, we have even less obligations since I am not rushing to get the kids out the door in the morning. This flexibility allows me to be available at the drop of a hat when the school calls because someone is sick and needs to be picked up. If we didn’t get to errands on the weekends, I can run them any day of the week. I can take the kids to appointments whenever they need to go. Honestly, the flexibility is what I will miss the most. Even though my schedule is incredibly forgiving for full-time work, it is still a schedule. It is not easy for me to cancel a full day of patients because I hate letting my patients down (especially when they may have waited months for an appointment) and I hate creating more work for my colleagues and administrative staff.

I have really cherished the time I’ve been able to spend at home with my children this year. 2020 has been an incredibly unpredictable year and, at times, incredibly challenging. But I feel so fortunate to have had this time, and I will hold on to these memories as I transition back to work in the new year. One lesson I’ve learned is that quality is much better than quantity. When I have been home all day with the children, it is impossible to have fun activities planned all day long and to engage with them fully at every moment (especially when there is cleaning to be done, food to be cooked, etc). I feel confident that I can still incorporate a significant amount of quality time with each child when I return to work.

So I will spend these next few weeks cherishing each additional unburdened minute with them and reflecting on how to incorporate more of that time into a busier future. And I will also be looking forward to returning to a sense of normalcy – for myself – through my career.

Gratitude

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If you had asked me this time last year what 2020 would bring, I would have never predicted any of this. A global pandemic, working from home, our children out of school for months, wearing an N95 and face shield to see each and every patient, Zoom classes for a 4 and a 5 year old, walking around downtown wearing a mask, a scarcity of paper towels and hand sanitizer, not seeing our families for months…it seems surreal reading those words back, even though they are things that actually happened (and are happening) this year.

Someone shared this image with me today and it seemed so fitting to read on Thanksgiving Eve. As an adult, I recognize that this holiday is not the idyllic pilgrim/Native American bonding fest that I learned about in school. It also wasn’t a huge holiday in our home. We were immigrants, my parents disliked turkey and I was a vegetarian, so we only really started celebrating when my younger brother was in school because he found out that all of his friends were eating turkey! But through the years we have come to define this holiday on our own terms. At the very beginning of our relationship, my husband and I celebrated at his aunt’s home, a family tradition for them and my first introduction to the extended family. We would drive or take a bus to see our families. Once we moved out West, we enjoyed a number of Friendsgiving festivities, since the holiday break always seemed too short to fly out East.

This year, we will be celebrating alone as a new family of 6. We are ordering a traditional Thanksgiving meal, because the thought of cooking with four little ones running around and no one to entertain them is too much. We’ll surprise the kids with gratitude lists – a compilation of why their parents and siblings are grateful for them. We’ll watch the Macy’s Day Parade, run our own Turkey Trot (a 1 or 2 mile loop around the neighborhood) and choose toys to donate to a local school district. I feel more fortunate than ever to have created this sweet full nuclear family during this incredibly tumultuous year.

While compiling photos for our 2020 photo book, I began to see our adventures this year in a different light. So many photos of the local park, where we went for days upon days upon days, because it was close to home and had bike trails and few people – the place where our then 1 year old learned to ride his strider bike like a champ. Photos of us walking, biking and scooting around the neighborhood – devising different routes to spice things up. The countless workbooks and crafts we coordinated for the kids to do – so many pictures of them gathered around the dining room table working on one thing or another. The forts and pillow creations and countless games of “lava”. The bounce house we finally caved and bought, and how when the wildfires were raging we set it up in our living room to get the wiggles out. The summer weekends spent in an isolated area of the beach, the kids first venturing timidly to the water and then donning wetsuits and bodyboards so confidently that we had to move them to a beach that was safer for little ones to swim in. Reimagining birthdays – photos of home decor, cakes, presents. The time we celebrated the birthday of two stuffed animals in our home just to have an activity for the weekend (also learning that stuffed animals are now called “stuffies”). The boys spending most of the day half-naked in the backyard, doing all sorts of water play and venturing over to the “hot side” of the house to have their picnic lunch. A first day of school photo in front of a laptop and a white board when our oldest child’s school launched a virtual curriculum at the start of the year. So many great memories that warm my heart.

Like most hard things, the photos show only the good times. Missing from them is the fear as COVID-19 spread to our community. The uncertainty at the hospital – when do we wear masks? How do we screen patients? Will we run out of PPE? Seeing patients while pregnant, hoping I wouldn’t get sick. Coming home and showering immediately before allowing the kids to come close to me. The disappointment as we canceled trip after trip – wiping away tears when our children cried to see their grandparents. The fear of having to go to the ED postpartum and worrying about exposing my 3 day old to COVID. My oldest saying “I’m so sick of coronavirus. I’m tired of hand sanitizer and wearing masks. I wish things could go back to normal.” The weight of trying to make everything okay for your kids, when things in the world were so far from okay.

But we have been lucky. We have not gotten sick. Our parents have not gotten sick. My husband and I still have our jobs. We have not suffered financially. Two of our children are able to attend school in person. I am immensely grateful for all of that and more.

So this Thanksgiving, I am choosing to reflect on the positive notes in those photos. Years from now, that is ultimately what I will remember the most. A special time when all 5 (and then 6) of us were able to be safe at home together. No school, working from home, then maternity and paternity leave. A special time to bond while our children were young and wanted to spend time with us. My goal for the next few weeks, in anticipation of returning to work, is to enjoy these moments as much as possible. As difficult as they can be sometimes, I know that I will miss them immensely when they are gone.

No more cornflakes

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Today is Day 38 of no school for my kids and Day 33 of shelter-in-place. It’s 1:48am and I am up again. We’ve been battling bedtime with one of my kids for what seems like an eternity (a year perhaps?). With the extra time at home, less need to be at work first thing in the morning, and generally more exhaustion, I have started falling asleep on the floor of his room (his preferred sleeping arrangement) more often than I would like to admit. After sleeping a good 3-4 hours, I find it tough to seamlessly transition to my own bed. Thus why I am up right now – writing for the first time in ages.

The past few weeks have been an adjustment, to say the least. Before I go into details, I first have to say that we have been very fortunate. My husband and I are still employed and no one we know or love has been ill with COVID-19, despite much of our family living in New York and New Jersey.  I work at a hospital but my department has made patient, faculty and staff safety a priority, and this has helped to relieve a lot of exposure anxiety. I am also 19 weeks pregnant and my colleagues immediately volunteered to take over some of my riskier patient care responsibilities, as the evidence regarding COVID-19 and pregnancy continues to evolve (fortunately, it has been mostly reassuring, but we are learning more each day).

We are very blessed and acutely aware of this, but also affected by the monumental change that occurred in our lives these past few weeks as well as the uncertainty regarding the future. What began as a two-week hiatus from school after there was a confirmed positive in the larger school community was gradually extended, until they just recently announced that school would be out until the fall. Summer camps have started to cancel. There is talk of the 2020-2021 school year looking dramatically different.

I do feel fortunate that my children are young (1, 3 and 5). Mostly they have reacted to the news with glee. For them, it is an extended vacation and their parents are home all day on most days (I am currently going into the office one day a week for essential procedures). They say they do not miss school or their friends. We live in a warm climate where they can go outside each day – even if it is only in our backyard or a short trip around the neighborhood. But I do worry about the change in structure. This week in particular was tough became it came with some change in behavior. My 1 year old is undergoing a sleep regression – often crying before bed, waking up in the middle of the night (he woke up as I was typing this), and a few mornings waking up before 5am. My 3 year old finds his way into our bed more often than not (perhaps related to my falling asleep on his floor most nights?). My 5 year old, who is generally very well-behaved, started to act out this week. Small things, for sure, but they pile up quickly when my husband and I are home all day, trying to fit work into any snippets of time we can find, and generally exhausted/operating on fumes. Parenting 3 kids 5 and under while both working full-time was hard at baseline and then COVID happened and it seemed almost impossible. (But I remind myself daily that at the height of my struggle with infertility I would have prayed for this conundrum. No matter how many kids I’ve had, there is no way to forget that burning desire for motherhood, the disappointment that came with every negative pregnancy test, and the fear of it never coming to fruition.)

And yet. Today was a hard day (also a hard night, it seems, with 2/3 of the kids already up 2 times each) and I started thinking about one of my favorite books from childhood – No More Cornflakes by Polly Horvath. I had forgotten the general plot and had a good chuckle when I read the Amazon synopsis: “Hortense seeks the advice and friendship of her eccentric Aunt Kate when her mother spends her days eating cornflakes and hopping around in public, pretending to be a rabbit”. It is about a girl growing up in a changing household – her mother is pregnant (and apparently losing her mind?  I should go back and read this now that I am an adult), her older sister is out more/becoming more independent, and she finds solace in a deepening relationship with her quirky aunt. The one thing I vividly recall, even decades later, is her aunt’s advice to find an “oasis”, a small ritual you have for yourself each day – one that is yours and only yours, one that brings joy always.

I love this concept even more now. As our world has become smaller – confined largely to the walls of our home – as our social interactions have become non-existent, as our opportunities for experiences, vacations, etc., have dissipated before our eyes, how do we find solace in our day? What can we do to bring a sense of peace, calm and fortitude into our lives? I’ll be thinking about this deeply in the next few days, as we continue to refine our daily schedules, to bring small rays of sunshine into our lives.

For now, I am trying to focus on the positives. I have had the opportunity to experience staying at home with my children (I went back to work with all 3 when they were ~4 months old). They have had the opportunity to experience a different childhood (I sometimes joke that it is my childhood) – one without planned activities, playdates, structure. We, as parents, are working on encouraging more creativity and independent play. We are trying to find small pockets of time for ourselves while the kids are awake, so that we don’t have to cling so desperately to the post-bedtime hours. My 1 year old’s language has taken off exponentially now that his brothers are home full-time. My 3 year old rode his bike for the first time today without training wheels. My 5 year old has been reading on his own and doing math. We are eating at home every night (we always ate together, but did often eat out) and I am so incredibly fortunate that my husband cooks for us every day. We are finding the time to complete random items on our to-do list that always fell to the bottom of our busy days.

One day, as long as everyone stays healthy and safe, we may look back on this time with some degree of fondness. I wonder if it is the closest we will ever be as a family. Soon, if we are still sheltering in place and socially isolating when this fourth baby arrives, we will be even closer!

This is how it often is

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We met on her second day of hospital admission. She was in her early 30s with a newly diagnosed leukemia. Her symptoms had been mild to start, and now she was here, admitted with cancer, about to begin chemotherapy. She had a six year old daughter at home. The walls were filled with artwork, family photographs, the annual Christmas card.

This is how it often is. You don’t have cancer until you do. The symptoms are mild at first – “I thought I had a terrible virus”, “I was so run down but I had been working so hard”, “My back was aching something terrible but I had just started CrossFit”. You’re living your normal life until it shatters.

I am a dermatologist who sees patients in the hospital when they experience side effects from cancer treatment, or have had a bone marrow transplant with skin complications, or have skin disease in either setting. This is not the role we usually envision for dermatologists. When I was an intern at a renowned academic teaching hospital, the ICU attending skipped over me while we were reviewing a chest X-ray on rounds. “You don’t have to know how to read this – in a few months you’ll just be doing Botox.” I was sleep-deprived, short on caffeine and the low woman on the totem pole, so I swallowed my tongue and folded it up as an anecdote I would later share with my own residents. As one of my mentors always says: you have to show skeptics your value, not tell them about it. Eventually they’ll come around.

The things I love most about medicine – the connections I have with my patients, the trust they have in me, the things I learn from them – are sometimes the hardest part of medicine. Patients often share their hopes and fears. They tell me things they have only told their closest families and friends. I had unprotected sex with someone who wasn’t my husband. I tried to kill myself. I don’t want to die. I never wanted to have children. I grew up in foster care and never had a family who loved me. It’s heavy. There is never any judgement, just a deep understanding of how complicated our world is. There is so much loss and pain, and on the flipside so much beauty and love.

Many times, my patients are soon in remission. The cancer was removed surgically, the cancer treatment worked, the bone marrow transplant gave them a new chance at life. I often don’t see these patients again, but some continue to visit me each year for a routine skin check, or because of a new rash. Those are joyful visits. I receive updates on wedding anniversaries, growing children, grandchildren, vacations – general life excitement.

Other times they never leave the hospital. Or they arrive to the hospital a different person. The complications pile on, everything goes wrong. Soon there is a planned discussion between oncology and the patient’s family. How aggressive do they want to be if new complications arise? Is it time to transition to comfort care? Whereas the first time we met they were sharing photographs of their families and explaining the artwork on the walls, they are now hooked up to machines and unable to communicate beyond a blink. I still talk to them when I enter the room. I repeat who I am and what I am doing – “I will be taking a look at your skin. Your oncologist is worried about the new blisters on your legs. Is it okay if I lift up your sleeve?” The syllables fade into the air, surrounded by assorted alarms. I finish my exam, say good-bye.

The next day we arrive to round and the family is huddled around the bedside, family members spilling into the hallway. The daughter is there. This is usually a sign that the patient has a few hours to live. It is a terrible moment for physicians. I wish I could shield my residents from it, in the same way I yearn to shield my children from the terrible things that happen in our world. We move on to the next patient but there is a heaviness in the air. A six year old is about to lose her mother, a husband is about to lose his wife, parents are about to lose their daughter. The hospitalization ends here but the repercussions of this loss will resonate for eternity. Eventually it will be explained as my mother died when I was six, but there were days and weeks and months and years leading up to that moment which were filled with all of the details that make our lives rich.

I sign into the hospital’s electronic medical record at home that evening to finish notes. I see that our patient has died. My children are sleeping in their beds and my husband is working on a deadline next to me but a mother has died. I move on to the next task, almost in slow motion. This is how it often is. You don’t have cancer until you do. You’re breathing until you’re not. You’re alive until you’ve passed.

What I’ve learned is this: there is nothing to do but to keep moving. Cherish the small things in life, keep your family close, take care of your health. Tomorrow is not a guarantee, trite as it may sound. Wealth and accolades will not shield you from disease and death. At the end of the day, we are all left with nothing. Ashes to ashes.

To my fellow physicians-I see you in the trenches, trying your best to keep your academic hats on while retaining your humanity. To patients everywhere-your doctors truly care about you. They think about you long after you’ve left their office and often long after you’ve left this earth.

I still remember my patients who have passed. I keep the trinkets they gave me, write down their quotes and life lessons, and have stored away the memories we’ve shared. Medicine is broken in so many ways – out-of-touch administrators with unreasonable demands, insurance companies refusing access to care, astronomical cost – I could go on and on. But all is not lost as long as the purity of the patient-physician relationship remains.

Bad news

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This month has been hectic. It started with a lovely get-away (without kids!) for my husband and I. It was lovely. We were away for a week and were able to sleep 10-12 hours per day, finish both our conversations and our meals, lounge leisurely by the pool (under an umbrella, of course), walk along the beach, read, and simply be.

As always, I returned home with a desire to incorporate some of that into my daily life: taking a few minutes per day to just be together, reading more for fun, enjoying leisurely meals, exercising. Except we came home to a 1 year old and a 3 year old and two full-time jobs so none of the above happened.

It’s also a busy time. I’ve been taking advantage of my second-trimester energy to complete a few projects, including submitting plans for a minor home renovation. I’ve also had a pesky cough since our time away and though it would go away but it didn’t, and the coughing would often rob me of my energy and cause me to feel even more tired than usual. To top things off, my oldest came down with hand foot mouth disease (HFMD) and was home the entire week prior to a flight I was taking solo with both kids. He was in pain and cranky the entire week (apologies to all of the moms I counseled on HFMD by saying it was merely viral and would blow over) and, the worst part of all was that he wouldn’t sleep through the night! So the first few nights my husband and I stayed up with him. And then my youngest got a fever (but fortunately did not erupt into HFMD) and then HE wouldn’t sleep through the night.

So I set off with both kids in recovery ALONE on a 6 hour flight and it was by far the worst flight we’ve ever had. My kids have traveled a lot because even though we don’t live close to family, I think it’s so important for them to spend time with them. They are usually shockingly well-behaved. I come prepared, keep them entertained, and they generally keep their crying and tantrums to a minimum. But last week was a different story. Both kids were on the mend, I felt like crap from a combination of not sleeping as well as fighting off this cough (oh and being pregnant), and they wouldn’t nap! So we kept things pretty together until the last 30-45 minutes. And then when the plane landed, all hell broke loose. Both kids wanted to be carried but I only had two hands and had to carry the carry-on bags (we only had travel backpacks with us but it was a lot to juggle!). Then my oldest started throwing a tantrum about everything – he didn’t want to let me into the aisle to organize our bags, he didn’t want his brother to sit by the window, and on and on and on. Meanwhile, I’m frantically trying to organize everything while his little monkey of a brother is climbing over the seats. My oldest won’t move from his spot so I tell him “I’m going to pick you up and sit you down here so that I can grab everything” and do just that. He loses his **** and starts yelling “Mommy you HURT ME!”. Meanwhile, I’m dying.  As calmly as possible, I tell him it’s time to get off of the plane. A very nice lady helps with one of our bags, I carry my youngest off the plane, and my oldest begrudgingly drags his bag and follows behind, complaining all the way.

At the gate, I have to find and unfold our stroller, which was a waste of effort because neither kid will sit in it (but at least I can pile some bags on it). The oldest is crying and blocking people as they walk off of the plane while the youngest just wants to be held. I hightail it out of there with the oldest hitting me on my backpack and throwing the world’s greatest tantrum. We are the last people off the plane and the pilots are begrudgingly walking behind us because (I learned on another trip) they can’t leave anyone behind when they leave the plane. Awesome. And then, to top it all off, I have to walk approximately 20 minutes with one kid in my arms and one kid whining the whole way because we have landed at a huge airport, at possibly the furthest airline!

It was a total disaster. I saw my parents at the exit, handed the kids off to them, and then walked off to baggage claim to burst into tears. I could tell the security guard knew I was going to lose it because he let my parents follow me to the baggage claim to help out with the bags.

Until yesterday, I thought that was the worst thing that had happened. Then, my ob called me. Before I left, I had a few third trimester labs drawn. Apparently, one of those labs was toxoplasmosis. I had already had this checked in January (at 7 weeks) and both IgM and IgG were negative. For some reason, my ob rechecked it. She admitted that this was controversial – that many people don’t recommend rechecking due to low likelihood of infection in our area and false positives. But then she told me that I had a new positive (IgM, with IgG still negative). She wasn’t sure what to make of it. She had spoken to the high-risk obstetrics group at my hospital and they would follow up with me and likely have me return for an ultrasound, as well as labs, maybe an antibiotic, etc. She told me not to freak out so I promptly did just that – freaked out.

Toxoplasmosis!? That’s one of the terrible infections we learn about in medical school that can cause a slew of problems in newborns. WTF!? But I don’t own any cats…and I’m a vegetarian! I couldn’t believe it. I did what I always tell my patients not to do – turned to Dr. Google, and PubMed, and every person I know who is an obstetrician or infectious disease expert. I received a slew of responses: it’s probably nothing/a false positive, you definitely should not ignore this, you need serial ultrasound monitoring, they need to test the baby, there’s nothing you can do anyway because you’re 24 weeks along.

I’m also a bit annoyed at my ob. Why did she check it if it’s controversial? Her exact words were “I’ll probably change my practice after this”. And I am not entirely sure she knows exactly what to do at this time. She referred me to the high-risk ob, and that person called me, but I’m traveling and can’t be seen tomorrow, and she’s going to be out of town next week. The ID expert I spoke with told me to get labs ASAP, but the ob told me it wasn’t time-sensitive. Her exactly words were “I’m going to be blunt with you because you’re a doctor: if this is a true infection, there’s not much you can do at 24 weeks”. But shouldn’t it matter if it’s a true infection?

So I’m just waiting here, anticipating the worst. And it’s made me realize that I’m done having kids. I always thought I wanted a fourth, but pregnancy is too tenuous and stressful. I think about the experiences I’ve had with my kids – my pre-eclampsia scare with my first and him being in the NICU after birth (the briefest NICU stay ever, but seemed like the longest to me), my positive first-trimester screen with my second and having to see genetics for additional screening to rule out a chromosomal abnormality, and now this with my third. I pray that he will be healthy. That this is either a huge misunderstanding (false positive) or that he does not catch this infection. I’ll have an ultrasound in one week and hopefully will have some additional information at that time – and hopefully it’s all good news.

Vulnerability

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I don’t write much about being a doctor because I do it every day and I prefer to write about non-medical topics, but my absolute favorite part of doctoring is meeting different people and hearing their life stories. I’m admittedly slower than I should be because I love hearing about people’s families, childhood, histories, etc. With my return patients, I always ask for updates and love to learn about what’s new.

Doctoring is a lot like waitressing – another job I really enjoyed. It can be tough on an introvert and draining after a long day of multiple patient visits. It can be taxing not only because of volume and patient turnover, but also because of the heaviness of the stories I hear. I am so honored that my patients share with me the things that they do. I keep these stories with me and often recall snippets years down the line.

Many years ago, one of my patients gave me a shark-tooth necklace. He was dying and making necklaces during his time in the hospital. I still keep this tucked away in my jewelry box, almost a decade later. It was my first gift from a patient, and he was one of the first patients I encountered during medical school.

Similarly, snippets of conversations weigh heavily on my mind. I think about my treatment plans – was everything correct? What will that one outstanding test say – will it change my management? How is my patient who just left the hospital – has she improved? Being a doctor is a tough job to leave at work. I can rarely escape it.

When I was growing up, my father would say: “Don’t become a doctor to make money.”

When I was in medical school, people would say: “Medicine isn’t what it used to be.”

I have known people who have dropped out before medical school, during medical school, after medical school, during or after residency. It’s not for everyone. You don’t clock in at 9:00am and clock out at 5:00pm. My husband will ask “How come if your last patient was at 4:00pm you didn’t come home until 6:00pm?” and it’s because medicine is messy and patients can’t be tucked neatly into 15 minute appointment slots. Also because there’s a load of electronic documentation that has to be done – but that’s a story for another day.

It’s rarely easy but I love what I do. The hours fly by in a blur. The patient encounters invigorate me. I learn something new every day and I come home with the knowledge that I have had a positive impact on someone’s life as well as their health.

What I would say to someone choosing a career in medicine: it’s so hard to know whether you will love it. And it’s true that so much has and will continue to change within medicine. But if you love science, interacting with people, and healing, it’s a great career choice, so don’t focus too much on the naysayers.

 

Just okay

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These two articles really resonated with me. One from today’s New York Times and another from a blog, written some time ago.

Am I okay with a mediocre life? All of my life I have been an overachiever. In fourth grade, we were assigned a state and we had to write a paper on that state by the end of the year. This was in the early days of the Internet. In order to write a paper, you actually had to go to the library, use the Dewey decimal system, find your books, take notes, and then write. I vividly recall freaking out in December because I was worried that my paper, due in May, would not be completed in time.

One of my earliest friends recalls a transportation presentation that I blew out of the park in sixth grade – she still talks about it to this day, and it is probably the only reason we became friends.

In eight grade, I swept the middle school award assembly – my name seemed to be called after every category. It was almost comical.

I could go on, but in sum: everything honors, AP classes, SATs, Ivy League, MCATs, medical school, matching into a competitive residency, academic practice.

And here I am today: a husband, two kids, a home of our own, great careers, good health. I’m happy, but I’m not sure if I should be wanting more. I see people around me opening up their own practices, starting their own companies, becoming Insta-famous, working as media experts, creating ground-breaking innovations, involved in amazing research, and on and on. It all looks and sounds great but sometimes the thought of it just makes me tired (it may be the thought but also highly likely that it’s the kids). I like my quiet life: quality time with family, taking great care of my patients, teaching residents and medical students, barebones social media presence, just trying to be better every day.

Is this enough? It sure feels like it, but does this mean that I am done being an overachiever? When is it okay to stop wanting more? For someone constantly in motion, when is it okay to stop and just be?