The game of Life

Back CameraI’m a working mom, but being a mom doesn’t define my career goals.  Long before I ever thought about having children, I had decided that I wanted to be a primary care physician.  In fact, I went to medical school to become a primary care pediatrician and felt so strongly that this was my path that I would have switched professions rather than settle for another specialty.  It’s true that primary care affords me many luxuries as a working mom though, including no overnight calls in the hospital, office hours that allow me to do daycare pick-up and drop-off, and flexibility in scheduling.  These are just added benefits to a job that I love.  These lifestyle factors are increasingly becoming more important to women in medicine and are why so many more women end up in general pediatrics and primary care, whereas fields like cardiology and critical care are predominantly men.  It makes me feel bad for the women in these fields who have to make significant family planning decisions based on their career interests.

Recently though, two physicians have asked me if I was only doing this job for a few years or when I was going on for my fellowship.  The assumption here being that a former CHOP chief resident wouldn’t do primary care except for the lifestyle factors and that motherhood must have contributed to this decision.  I doubt that this question is asked to men in primary care.  I resent that there are still pediatricians who look down upon the important work that primary care physicians do and view my career as a loss of potential.  I am also saddened that while being a working mom in primary care is viewed as a “good choice” for raising children that the opposite is then thought of the working moms who follow their passion to the PICU/NICU/Onco [insert your favorite fellowship].  These moms face different work-life balance challenges than I do, but this doesn’t mean they love their children less or are less committed to motherhood.  I don’t think we should judge working moms based on how competitive we think their careers are, or aren’t.  I have many great mommy role models who work 30-hour shifts, weeks of nights, and 9-to-5.  We all do the best we can as mothers and doctors within the construct of what our specialty allows and in the more inspirational cases, we change the definition of what is allowed.

So the answer to your question is, I’m doing this forever.

All Better

Image“This is the doctor, she’s going to make you feel all better,” countless moms have told their children as I try to examine them.  As a new attending physician, this statement weighs heavily on me.  Will I actually be able to make them feel better?  Our hospital’s latest marketing slogan is “All Better,” which suggests that it is my job to make this come true.  The last mom who promised her child this came in with a viral syndrome.  I was able to make the diagnosis, but unfortunately there was no treatment to be doled out and the only promise I could fulfill was that I expected him to improve in 3-5 days.  While I felt bad for the child, I think I felt worse for the mom because I had failed holding up her promise to her child.  Fortunately, there are many more cases where I am able to provide an answer and remedy, proving a mom right that the doctor really can make you feel well again.

The first time that my son fell and looked to me for comfort, I felt the magical power of being a mom.  Without any special skills or tools, other than hugs and kisses, I am able to soothe bruises, mend abrasions, and rejuvenate the spirit.  When I know his injury is minor, I am overjoyed to scoop him up give him hugs, and let him dry his tears and sniffles on my shoulder.  I am mom.  I am the one person who has the birthright of this role, but I work daily to maintain this privilege. There are few other roles in life other than mother that give you such an entitlement.  I have the fortune though of filling this role at home and at work.  The same way that my son looks to me for comfort, relief, and cure, children coming into my office have the same expectations.  However, when a recent fall landed us in the Emergency Department for stitches, I had to focus on my role as mom and not doctor, and like all the moms who come to see me, I promised my son that the doctor would fix it.  While I knew I could have done the procedure myself, I enjoyed being the one who wasn’t causing him to cry but rather letting him know he was safe and loved.  When the doctor was done and I kissed the salty tears off his face, I found myself saying, “now you are all better.”  And we both were.

Portrait of a young artist

Moving into a new house makes you imagine the future.  I’ve pictured how my son’s new room will look, where he will ride his first bike, and where he will do his homework.  However, packing to move into this new house forces you to confront the past.  Instead of throwing everything into boxes, I’m trying to pack wisely and eliminate the clutter that accompanies us.  While it may be easy to part with my medical school review books and clothes collecting dust in the back of my closet, any memorabilia relating to my son is much more difficult to spare.  Sorting through each construction paper scribble project makes me nostalgic and since he’s only been scribbling for a few months, they aren’t even very old yet!

Years ago, I went through this with my younger sister.  Since I’ve lived outside my parents’ house for her entire life, my mom has mailed me pieces of her artwork over the years and I saved every one of them.  During this time period, I moved many times and each time packed up her artwork and filed it in another desk/dresser/bookshelf.  Eventually, I came up with the idea to scan each item and make a photo book, which not only organizes the pieces in a tidy format but preserves them through each move and over time.  Now that I am mother to my own little artist, I need to start scanning again so that I can save each project electronically and save the most special pieces for display.

In addition to packing for our move, Hurricane Sandy has made me think about what items in my home I value most.  The mayor and governor talk about taking your “most valuable possessions” with you in the case of an emergency evacuation.  Besides the people and pets in my home, what would I take?  Years ago, I would have said my photo albums, but now most photos are digital.  So many of the things that are precious to me are the little reminders of the good and bad times over the years, because after thirteen years with my husband, six years of marriage, and 19 months of being a parent, I know how quickly it all goes and I want to cherish it all.  As I’ve seen through my sister’s art, children’s drawings are a great way to see their perspective and development over time, which is why these projects are so special to me.  While N’s current art consists of scribbles and glued tissue paper, I am excited to see his progression and add each new masterpiece to his portfolio.

Raw Image

An intern recently presented to me a premature baby discharged from a two-month NICU stay to her 15-year-old mom.  The intern’s eyes were wide as she read the pages and pages of NICU jargon that she was expected to synthesize into a plan for this baby.  After we discussed the primary care of a premature baby in general terms, I held up the discharge summary and said, “If this overwhelms you, imagine how this mom feels bringing home this baby.”  This pile of papers translates into a very tiny baby, who has already had an eventful life, and his young mother who has to learn how to meet his needs while maintaining her own identity.  “You need to go back in there and give this mom some encouragement and support.  That is the most important thing you can do today.”  This is how I feel about most newborn well visits.  After making sure the baby is healthy and safe, much of what I do is partnering with the mothers (and fathers) about how difficult, and yet amazing, their job is.  There is so much about those first few weeks that makes you barely able to recognize yourself or your former life and while you love your new baby more than anything, you dream about a full night of sleep and the freedom you once knew.  It helps to hear someone who has survived it all tell you that you will too.

I recently read another blog post about moms allowing themselves to be photographed with their children, despite their insecurities and lapses in hygiene.   I wrote earlier about how to dress your post-baby body, but I’ll admit that there aren’t a plethora of photos of me and my son to choose from for exactly the reasons that Allison Tate mentions, including putting my son’s grooming and fashion before my own.   However, I was asked for work to submit a photo of myself and my son for a newsletter and while scrolling through thousands of photos on my iPhone, I scarcely found any featuring myself.  I imagined that someday my presence in my son’s life would be undocumented (besides this blog!) and since then have tried to hand off the camera more often so that we can capture these moments.   I want my son to see the joy on my face when I am holding him, the bags under my eyes because we were up together all night, the pucker of my kisses all over his head, and the body that gave him life.

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Every so often, a family asks if they can take a photograph of me with their baby– usually to document their first exam.  I love these requests because it reminds me how special my work is when it starts to feel routine.  Lately though I have been the one asking families if I can photograph them.  One mother of nine had seven of her children in my office and while we were talking they had all managed to climb onto the exam table, sitting there with legs dangling like the photo of the men atop the skyscraper, so I asked if I could capture this on her camera.  How often could this mom possibly get photographed with her children?

For all the moms I see in my clinic who don’t have the ability to hand off their camera to others, or don’t have the mommy friends that I have to share their feelings, and can’t imagine that one day things will get easier and that the sleep and freedom they once knew will return, albeit in a different way, I try to offer them small pieces of that in 15-minute increments.  As mothers, we need to support each other and create a community that highlights the important work we do every day.  And while sometimes I am not sure what pearls I have to offer the brilliant residents with whom I work, my experiences from the trenches of motherhood are always freely shared because I think these are some of the most important things a young pediatrician can learn.

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Bananaman

When your toddler has a tantrum, ignore it.  They want you to give them attention, and if you do, you reinforce the behavior.  I tell this to parents in my office almost every day.  Now that I have an 18-month-old at home, I do my best to follow my own advice and appreciate how hard it is to be a textbook perfect parent.  Beyond the embarrassment and shame you feel in front of other parents, there is the genuine concern for your child—maybe he is actually suffering—and your own personal desire to end the tantrum (and everyone’s misery) by giving in.  I am not easily rattled, though, so I usually hold out and this strategy was working well until I went to Whole Foods.

N has recently become obsessed with bananas, so when he shouted “nanas” and pointed toward the produce section, I figured it was a good idea to stock up.  While the bananas sat on the check-out conveyor belt, they seemed to taunt him and he descended into a banana-frenzied fit, complete with tears, frustrated pulls of the hair, kicking, and swatting away any substitutes I offered.  I thought to myself, well, he isn’t starving and they aren’t even ripe yet, so I’m just going to ignore him and hope this passes quickly.  I could feel the stares and glares from all around me.  I willed the cashier to speed up, but I held my ground.  Then, the Whole Foods Customer Service representative came over and said, “If you just want to give him a banana we won’t charge you.”  I was mortified that it had reached this point.  “It’s on the house!” he exclaimed, proud that he had solved this problem.  Doesn’t he know that this will only make it worse in the long-run?  I wanted to say, “Oh, why didn’t I think of that!” but instead, I surrendered, peeled, and handed over my power to my toddler.  As he furiously shoved the banana in his mouth, acting as if this was the first time I had ever fed him, I scanned the faces of the other customers hoping not to recognize anyone.   No friends, no patients, no DHS workers—phew.

There are times when every mom feels like a failure and tantrums certainly highlight these moments.  The next time we were at Whole Foods, a mom standing next to me apologized for her son’s whining with “I’m sorry, he’s a little wild,” and I gave her a knowing shrug and “so is he.”  N was amazingly calm though and a Whole Foods employee actually rewarded him with a knit giraffe.  This made me feel like the many moms who have reassured me in the past but then seemed to have angelic children, making me hate them even more, and I felt guilty for being on the other side.  I still give parents the same advice about tantrums, although I know we all break the rules sometimes.  Like toddlers, we all have our moments of success and failure.  One time Whole Foods is bribing you with bananas and the next time you are celebrated with handmade toys.  Either way, this kid has learned how to score Whole Foods swag.

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