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!

Monday, April 6, 2015

Using Rituals to Alleviate Stress

(Image courtesy of 9comeback at FreeDigitalPhotos.net)

We all incorporate small rituals into our lives, such as performing a particular order of operations or one little task that always has to be done before or after something else. For you, it might be the steps you employ to make your morning coffee. For a professional basketball player, it might look like a certain number of dribbles and false shots before performing that crucial free throw. I have witnessed many climbers perform elaborate rituals in the way they duct tape their knee pads to their legs or tie their climbing shoes (I'm looking at you, hubby!). This article says that these rituals are similar to those performed by patients with obsessive compulsive disorder. Within reason, rituals provide a sense of comfort, control, and efficiency, decreasing the massive decision making and head games that can flood each day. In this sense, they can relieve stress and also make some more arduous tasks easier (or possibly more enjoyable).

I've been using a ritual to complete a somewhat unpleasant daily task in my own life. I have to give myself an intramuscular shot of progesterone nightly as part of my current fertility treatment, and this could last potentially for up to 8 weeks! In order to keep myself motivated to do this on a daily basis, I've turned it into a flow-inducing process. Here are the steps:

  • First make sure belly is full of a delicious dinner and either herbal tea or hot cocoa.
  • Assemble all required supplies.
  • Place ice pack on desired buttock. Simultaneously warm a compress in the oven.
  • Pour a small amount of hot water left over from tea/cocoa making in a shallow bowl and place the progesterone vial inside (optional but helps to lower the viscosity of the solution, making it easier to draw up and inject).
  • When adequate time has passed (i.e. buttock is numb and burning from the ice pack), draw up 2 ml of progesterone with an 18 gauge needle on a 3 ml syringe.
  • Remove the 18 gauge needle and attach a 21 gauge needle. Do not skip this step or you will have a bloody, painful mess (believe me, I have done it!).
  • Clean the desired area with an alcohol swab and inject. Rub the area vigorously so as to distribute the medication. Do a little jiggle dance and move around hips to activate the muscle.
  • Top the injection site with a small bandage. Leave in place so as to know which side to inject tomorrow.
  • Properly dispose of all used materials (yes, I have my own sharps container).
  • The most important step: consume one Trader Joe's Dark Chocolate Honey Mint.
There you have it. I even incorporated treats into both the beginning and end of this ritual. Treats are integral to the adherence of habits, especially difficult ones. Check out this article from happiness expert Gretchen Rubin on why we need treats (and expect an upcoming review of her new book all about the subject of habits)!

Do you have any rituals that you do to make something more tolerable in your own day? Share them here!

Tuesday, March 17, 2015

Dear Dawn: How do you decide on a specialty?

(Image courtesy freedigitalphotos.net)

I got this comment on one of my blog posts and decided to turn it into a "Dear Dawn" post:

"Thank you for your wonderful weblog and wise words! Sorry if I'm commenting where I shouldn't be, but I wasn't sure where to ask this question. I'm just a med student but I noticed you're an anesthesiologist. That's really awesome! :) I'm interested in anesthesiology too. Have you by any chance written on anesthesiology and why you chose it? I'd love to read a post about this if you've written about it as I value what you've written here and I'm sure your thoughts would be amazing on this as I'm having a hard time deciding on a specialty? I know I'm probably dreaming as this might not be possible in medicine (so disillusioned sigh), but I'm hoping for a specialty where I can have somewhat of a life outside of medicine. That's my main goal, which I hate to say is the case as I feel guilty as maybe I'm not as devoted as others, but I'm just so burned out already, and want to focus on my family more who I have been missing a lot. I know I definitely don't like surgery as I don't like the work. I don't really like the wards (e.g., social issues, writing admission or discharge notes), but ironically I really love general IM a lot. I also like the ICU. I feel they're the doctors I imagine I've always wanted to be, but the big negative is I don't like the lifestyle of general IM or the ICU. I also like the ED a lot, and maybe that's another option, but I have heard night shifts are hard later in life. Family medicine is ok too but FM is maybe too slow-paced for me. I really like anesthesiology, as again I love the limited patient interaction but also I feel like the general medicine is amazing and I love "doing" things, but I keep hearing about the gloom and doom with CRNAs taking over and practices not hiring partners anymore, but maybe it's not true? I'd love to hear your thoughts if you might have written about this somewhere (sorry I can't seem to find any past posts but maybe I'm not looking in the right place or I missed it)? Thanks so much! :) Kate"

You're right, Kate. I have not written much about why I personally chose anesthesiology or how I recommend choosing a specialty. Based on your comments above, it sounds like you are already on a good path of asking about and observing the positives and negatives of various medical fields. Of course, it goes without saying that ideally you should be somewhat interested in the science behind the specialty you choose. But that is by no means a required factor and only a small part of the picture. With so many choices that have such broad range of everyday job duties, you can make yourself crazy trying to find the "perfect" situation. There is no way to accurately predict the future of the politics and business of medicine, so trying to base your decision on specialty demand or salary brackets is futile.

The truth is this: there is likely not going to be a specialty that has exactly everything that you want and nothing that you don't (and that holds true for any job or profession). Instead, I think the best way to approach the medical specialties (or any particular career path, for that matter) is to spend time learning about yourself. Focus on your own likes/dislikes and strengths/weaknesses:
  • What types of work environments and tasks do you prefer (hospital or clinic, cerebral or procedural)?
  • Do you like to work in a team, on your own, or a blend of both (the most likely situation, but certain jobs sway more one way than the other)?
  • What types of patients do you find that you are most excited to see? Describe your ideal patient (not that such a patient exists, but think about the age, gender, medical issues, etc. of patients that you enjoy seeing).
  • Do you do well in situations that are unpredictable, or are you most comfortable when you have a schedule and know what is coming?
  • How do you fare in emergency circumstances? Do you shut down or engage in "go mode"?
  • Do you have any particular disabilities that might make the practice of a particular specialty very difficult?
  • Lastly, think about your personal life and career goals. What are your values? How do you measure success? (More about this question in a future post!)
This may not be a clean answer to the question of how to choose a specialty or career path, but not many of our paths in life will manifest a clear, well-marked trajectory. There will probably be a few specialties that mesh with each person, and some of the decision will be based on temporal circumstances (such as the presence of a specific mentor, demand or competitiveness of a given specialty, etc. at the time of decision.)

Regarding my own decision, I started medical school with a specific interest in anesthesiology, given my background as a chemical engineer and some parallels behind the research science of the specialty. However, I was open to many other areas of medicine. I paid attention to my likes/dislikes in the basic science classes and approached each clinical rotation as if I would potentially pursue the particular specialty at hand. I observed the patient populations, the team interactions, the personality types and the lifestyles/happiness levels of the practitioners that I worked with. I thought about the every-day activities of each field and pictured myself doing them as an attending someday.

After entertaining specialties such as internal medicine and neurology, I ended up going back to anesthesiology for many reasons. The anesthesiologists where I trained seemed happy and had personalities that meshed with my own. I enjoyed the subject matter that was presented at the conferences and journal reviews. Through self-reflection, I realized that I craved diversity in my work day activities, environment, tasks, and patients. Anesthesiology is obviously performed on people of all ages, sizes, and disease states. The work tasks are a blend of manual procedures and cerebral problem-solving. It is performed in the hospital environment with a mult-disciplinary team, both of which I enjoy. The workday can be unpredictable in terms of length and caseload, but at least the call is usually infrequent (if in a large enough group, or if you get a no-call position like I have :)), and anyway most of the work is done during the day except for emergencies. There is the potential for some very stressful situations, but they are not constant. It involves no clinic work, which would allow me to travel for extended trips if I chose to. Etc etc.

I hope this helps! If you are in a medical profession or other specialized profession, how did you choose your field of practice? What factors went into your decision? Share your thoughts here!