Tuesday, June 16, 2015

When Do You Disclose a Pregnancy?

I was 5 weeks pregnant and working in the spine room. Just as I finished my intubation and secured the airway, I turned to set the ventilator and administer some important medications. The surgery fellow started to position the fluoroscope near the patient's cervical spine, about a foot away from where I was working. "Please don't use the Xray right now; I need to put on a lead shield first," I said. "Yeah, ok... whatever..." he said, as he continued to fine-tune its position. Thirty seconds later he sighed, then started pushing some buttons and eyeing the screen. I looked at him sternly and said, "I'm serious. Don't do it. I'm pregnant."

Yes, this awkward moment happened during my first pregnancy last year. A very similar situation happened again at work during this pregnancy, but I was a bit farther along. Many people wait until they are out of their first trimester to disclose a pregnancy, mainly because there is an unfortunate  cloud of shame in our culture that surrounds miscarriage. But in certain situations, depending on your occupation, I would argue that it is important to tell coworkers earlier.

In my new post for Mothers in Medicine, I explain why. You can find the entire post here. Let me know what you think!

Monday, June 1, 2015

Book Review: Better Than Before by Gretchen Rubin

"Changing a habit may be simple, but it's not easy, 
and the more tools used, the better."

- Gretchen Rubin, Better Than Before

Former New York lawyer turned happiness expert Gretchen Rubin constructed her first book The Happiness Project from blog posts framed around a year-long challenge of adopting a different habit each month in the hopes of enhancing happiness. Since then, she has written Happier at Home and now Better Than Before. In this new tome, she shifts her focus from happiness to habits. She states in the book's preface that the basis of making change in our lives is the use of habits. As I discussed in my post about rituals, habits conserve self-control and limit decision-making fatigue by turning something into an automatic task. And being a fan of fostering habits and trying monthly challenges myself, I had to read it! I have also read her other two books.

Her observations about happiness and habits are not arbitrary; she researched the topics and performed her own data gathering in order to come up with them. And some of her constructs admittedly are genius, such as her Secrets of Adulthood (revealed in The Happiness Project) and now her Four Tendencies (discussed in Better Than Before). She posits that all personalities fall into four basic tendencies when it comes to how they respond to expectations: Upholders, Questioners, Obligers, and Rebels. Where we fall will affect how we adopt, maintain, and drop our habits. If you would like to learn your type, there is a quiz in the back of the book and on her website to help you determine it. I am a Questioner with a tendency towards Upholder; my husband is also a Questioner with a tendency towards Rebel.

The book also introduces and explains numerous strategies for sticking to habits, such as distraction, treats, pairing hard habits with easy ones, and identifying loopholes people commonly use to avoid their habits. In addition to where you might fall in the Four Tendencies, reading this will help you learn if you are an Abstainer vs. a Moderator, and if you are an Opener vs. a Finisher.

If you are a Gretchen fan like I am, many of the concepts in this book will be familiar to you. She has been blogging and podcasting about issues surrounding habits for a while now, all in anticipation of the book's release. She even openly solicited her followers for material to add to the book during its writing! Come to think of it, her other books were similar; they are peppered with strategies shared by readers in the comments section of her blog. At first glance, openly discussing content that will be included in a book seems like a poor marketing strategy, but the added information gathered from her audience does enhance her points. In addition, she always adds examples and personal stories from her own experience to further solidify her concepts.

What I love most about this book is the importance Rubin places on knowing yourself as the key to adopting good habits. As I have pointed out, this is something that is also at the heart of effective stress management. Have you read this book or followed Rubin's work? Let me know what you think in the comments below!

Monday, May 18, 2015

Mothers in Medicine: Not Just for Moms

I am so honored to be one of the new regular contributors at Mothers in Medicine! MiM is a group blog that has been around since 2008 as a forum for female physicians to share their unique experiences navigating roles in both medicine and family matters.

The regular contributors range in specialty from pathology to OB to surgery to pediatrics... to many other fields, now including mine. In addition, the contributors vary in their level of training from premed students all the way to full-fledged attendings. While there are now 22 regular contributors generating posts at least a couple times a week, the site also welcomes Q&A and occasional guest posts. They even occasionally do topic weeks with a post from each contributor on an interesting subject, such as "a day in my life" or "how medicine has changed me".

This important blog is not just for mothers, nor exclusively for doctors. The wide subject matter presented could be useful reading for anyone in the throes of intensive professional training or anyone working to balance their profession with their family life. Check it out and watch for my posts under the pen name PracticeBalance!

Monday, May 11, 2015

Shoe-drop thinking: How to let go of the past?

(Yes, there is something growing in there!)

I'm pregnant, again... I'm almost 10 weeks along and definitely feeling symptoms of first trimester pregnancy this time.

No big announcements, clever texts or Facebook posts, no balloons or flowers or drama. Just quiet and cautious happiness... somewhat. You see, it's actually been difficult to enjoy the good news because I'm suffering from self-proclaimed "shoe-drop thinking"; things are going well, so when will the other shoe drop? When will that bad thing happen, you know, because something bad always happens?

I've felt exhausted on a new level, and the nausea started on cue right at 6 weeks. The occasional tugging in my lower abdomen signals the growing pains of my uterus (even though there's not much visible outward growth yet). I've had three ultrasounds that show perfectly-timed fetal growth and a strong heartbeat.

But when I have a day where I feel more energetic, I think maybe it's all over. I intermittently push on my ballooning breasts in hopes of detecting tenderness (my husband thinks I'm insane). If I don't have nausea for a while, a twinge of worry comes over me. What it comes down to is that I'm ironically glad if I feel like crap. I live for the next appointment, the glimpse of a little fluttering lima bean, the next evidence of reassuring progress.

I'm not alone in this thinking pattern. I have spoken to a few friends who have also had similar experiences. I always ask, "When did you stop worrying?" They always answer, "Never." I also recently came across this article from the NYT Motherlode blog and this article from HuffPost Parents, both written by women describing what it's like to be pregnant after IVF and/or fetal loss. The New York Times author even goes so far as to describe her experience as "IVF PTSD". While some of her feelings echo mine accurately (notably when she said, "I’m still mentally preparing myself for the worst, running through the scenario at the doctor: the silence of the ultrasound technician when something is wrong, the stillness of the fetus, the trauma of everything suddenly being over"), I would not consider myself to have PTSD. My IVF experience has been relatively un-dramatic compared to many, I have learned a lot from it, and I feel lucky that I know and understand the cause of my infertility.

Shoe-drop thinking could be an impediment to progress in other situations as well. How do people ever climb fluidly and without fear after suffering an injury in a fall? And in an even more common scenario, how do people drive after being the victim of a car accident? I suppose they regain trust in the process.

Because stressing and worrying is sure to be detrimental to my and the growing fetus' health, I'm working on redirecting my thoughts. I do this through journaling, meditating, or releasing the negative thoughts into the open air (with or without the presence of a good listener). I do some tapping of the meridiens along my head and neck while repeating a mantra, a technique that has been shown to help with feelings of anxiety and worry (for more info, check this out).

Shame researcher and vulnerability expert Brene Brown said, "We can spend our entire lives in scarcity . . . just waiting for the other shoe to drop and wondering when it will all fall apart. Or, we can lean into the uncertainty and be thankful for what we have in that precious moment." So my recent mantra is trust the process. I'm so grateful to be pregnant, and there will always be something to worry about. As other parents have told me, it doesn't stop after the baby is born!