What makes you a #bettermother?

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Nope, not a better mother than your neighbor, than your friend, or than the president of your local PTA…but what makes you the best mother you can be?  Going even further than that… What makes you successful as a person?  As a human being?

 

John C. Maxwell defines “success” as:

“knowing your purpose in life,

growing to reach your maximum potential, and

sowing seeds that benefit others”.

 

Very recently I was approached by www.inspiringwomeninsurgery.com to provide some words of advice or encouragement, and while my 4 year old was brushing his teeth at night I thought about work/life “balance”, envisioned a set of scales, and came up with this.

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Why am I a #bettermother because I am a surgeon?  Because I know my purpose in life, I am growing and I am sowing seeds.  I know that this mother may be sad that I miss my son’s soccer practices, but I also know there are lots of other mothers out there that are glad I did… because I was able to help their children in their time of need.  And although my children may miss me at times, I know they also gain valuable lessons from my career – independence and selflessness chief among them.  My children always know that I love them, and they are important to me… whether I am sitting at their bedside, or at the bedside of one of my patients.

And no, you don’t have to be a trauma surgeon or work outside the home to be successful, or a #bettermother.  Again, look at the definition.  Nowhere in that definition does it mention spending every moment of every waking day with your child(ren).  It doesn’t mention making your child’s first birthday cake by hand, or becoming Vice President of a company.  Nor does it mention “leaning in” to the point that you are about to fall over.

YOU are at the center of your success, and you have to give back to yourself in order to be in a position to give to others – whether that is your spouse or your children or your community.

An example for you.  The wife of one of my partners volunteers with her daughters’ Girl Scout troop.  This makes her a #bettermother – not because she spends time in an activity that involves her own children, but because she gives of her time to an activity that gives many children joy when other mothers can’t.  Another friend is a #bettermother because she is a Crossfit addict… She is teaching her daughter that strong is beautiful, and physical health helps build emotional health.

Taking time in activities, away from your family, work related or not, that develop your sense of self, fulfill your purpose in life, and replenish your soul is not selfish.  In fact, it is essential to being a #bettermother and a successful human being.

So what makes you a #bettermother?  Is it the 30 minutes you spent exercising this morning?  Or is it the 2 hours over the weekend you took to train for a marathon?  Is it the overnight business trip in another city that allowed you to present a project that will better your company?  Is it the hours you spend volunteering at your child’s school because other mothers can’t?  Is it that extra time you took at the hospital treating a patient who needed you?  Is it the time you spend organizing a book club giving women the opportunity to fellowship with other women, building their support system?

Success doesn’t require a title, or a degree, or a paycheck.  It requires YOU being the best YOU possible.

So take that time to develop yourself, replenish yourself, fulfill your purpose.

Enjoy it.  Own it.  And snap a photo of yourself doing it.  To keep as a reminder – when you are coming home late, or have 18 loads of laundry piled up, or serve Cheerios for dinner for the umpteenth time that week, or in any way feeling like you are “failing”…that you are, indeed, not.

I am a #bettermother, and so are you.

 

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Defining “Mommy Friendly”

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I had a familiar conversation the other day with yet another female medical student.

“I really loved surgery!” she said, “but I was concerned about the lifestyle so I decided on _______________.” 

Lifestyle, it turns out, almost always seems to be code for having a family (maybe it’s just the kind of students who are apt to seek me out as I have yet to encounter someone who is concerned that a surgical career will hamper their aspirations to compete in triathlons or become national fencing champions or write books for the general masses–I personally know surgeons who manage to work full time and do all of these).

The other day, I came across yet anther discussion board on what advice to give to women in search of “mommy friendly” medical specialties. There were lots and lots of suggestions, some were full time jobs with predictable hours and others were part-time jobs but not one of the suggestions was a surgical subspecialty. 

Not. A. Single. One.

Sigh. This makes me sad for my chosen specialty and for all the promising young women who will not go on to realize their potential as amazing surgeons.

I would be lying if I said that surgery is lifestyle friendly. In fact, anyone who has followed this blog for more than a millisecond knows that many of our daily woes outside of work arise from the demanding hours and high stress of our career choice. But the question is: What does mommy friendly even mean? This is not the same as the “mother’s hours” often noted as selling points in help wanted ads. There may be ways to go really part-time or certain very specific specialties that enable a woman to only have to be at work when her kids are at school I suppose. But I have to believe that mommy friendly is about more than just the hours.

I know, I know. You are just waiting for me to launch into the cliche of it’s quality, not quantity. But I won’t. 

Because the truth is I wrote all the words above nearly 500 days ago. It turns out I never finished because I don’t know what mommy friendly means when it’s used as an adjective for a career. 

Since I first wrote the beginning of this blog post, I have spent well over a year of my life as a surgeon and a mother. I even wrote an open letter to young women with the same opening line evidently having forgotten about this draft. That letter, now read more than 15 thousand times, doesn’t define mommy friendly either.  

Paid maternity leave. Private pumping rooms. Childcare. A promotion clock that doesn’t penalize for maternity leaves. 

To be sure any work place can provide these but do the amenities in and of themselves mean the associated profession is mommy friendly? Not if the backhanded comments or outright displays of resent persist. Often, the culture of the profession is at odds with these progressive work place policies. And these replies on what medical career to choose clearly indicate that the culture of medicine has not caught up to modern times. 

Luckily, however, not every one is reading the same message board. And so this week across the country a whole new crop of women begin training as surgeons. They are less a minority and more just reflective of the demographic of modern surgery. Hopefully, they will all become surgeons (there is still some attrition in our programs nationally) and some will become mothers. And my hope is that, together with the men they are training with, they will foster a culture in which is it no longer necessary to ask if surgery is a mommy friendly. 

An Open Letter to Young Women Considering a Career in Surgery

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Dear Young Woman Considering a Career in Surgery,

It was lovely to meet you the other day. Many times a month, a young woman just like you comes to me with similar interests and concerns. “I really love surgery,” she says, ” But I am afraid of the lifestyle and I really want to have a family.”

Oh, and thank you for also inviting me to speak at your seminar the other day on Women in Traditionally Male Dominated Fields. I have been speaking at similar panel sessions since 2005 when I was a bit of a novelty at my training program as a clinical PGY-4 with an infant daughter. Your collective curiosity on what my life must be like is of great interest to me because to me it’s just my life. It’s the only reality that I know because, like you, I was young (just a few days into my 25th year, just 5 days into my first ever surgical rotation) when it occurred to me that I really loved surgery. It was unexpected; but every day since then (from the remainder of that MS3 rotation, to my sub-internships, to my years in residency, to research and clinical fellowships, and to these past 6 years on staff) I have crafted a reality, as tenuous as it is, that works for me and my family in any given moment in time.

And I am here to tell you that you can do the same too if you, in your heart of hearts, can think of nothing more exciting than surgery as your professional passion.

People outside of surgery will tell you that it’s a career that is too hard to integrate with family life. They are correct that it is generally harder than other fields in medicine; but, ask yourself if you truly want a career in general pediatrics, or dermatology, or invasive cardiology or anything in between. If the answer for whatever alternate field(s) you are considering is no, then no matter how many fewer hours your profession requires, no matter how much more flexible those hours may be, your family will be left with a present, well-rested, yet bitter wife and mother.

[NB: I use the word integrate very purposefully here. Anyone from a demanding profession, surgery or otherwise, who tells you that work-life balance is possible is conning you. Your life will never be in balance. Something will always have to give: your work, your family, or yourself. It’s in how you integrate these things in a shifting, fluid professional and personal lifetime that you will craft your own reality.]

 

The same can be said of those who encourage you to enter surgery training but then offer that you may consider a career in breast surgery or start an exclusive vein clinic or choose some other presumably less time sensitive and/or less time consuming surgical practice to balance your professional work with your desire to have a family. Again, ask yourself  if you can truly be happy in such a practice. (I personally would be bored with only a few kinds of procedures in my armamentarium and the absence of physiologic chaos; but everyone is different.) You may not know the answer until you are well into your training; but, choosing a medical specialty in the first place, or a surgical subspecialty in the second, simply because you presume it will be easier for family life is fraught with potential for professional dissatisfaction. I promise you that professional dissatisfaction will always stand in the way of overall family life satisfaction. Always. Forever.

Finally, as hard as it might be to envision yourself as a surgeon who wants hobbies, and a spouse, and a smoking hot body, and children of your own someday,  remind yourself that divorced parents, widowed parents, disabled parents, parents with deployed military spouses, and parents with far fewer socio-economic resources than practicing surgeons, and trainees for that matter, somehow get it done. Every life has it’s particular challenges when it comes to parenting but surely being a surgeon is not the most insurmountable of them all.

So think long and hard about alternatives to surgery; but choose one only if it speaks to your professional soul. No matter what career you choose, you will likely spend more time at work than on any other aspect of your life be it parenting, self-care, love-making, you name it. Therefore, it is critically important that your choice of career light the fire in your belly to show up every day leaving behind, at least temporarily, everything else including your children. Because one thing is for sure: when you are practicing surgery, your head needs to be in the game. You cannot be distracted by guilt about not being with  your family or about delegating some of the more mundane aspects of childrearing or homemaking to others. You must love the work enough to drop the guilt and create practical solutions to raise your children and provide them with a safe and loving space in which to grow while reimagining whatever stereotypes you hold about being the perfect parent.

Because you know what: There is no such thing as a perfect parent, surgeon or otherwise. So there will never be any point in beating yourself up about it. Know that you will love your children more than you could have ever imagined loving anything, including surgery, but that you will still be a great surgeon. The two are not incompatible, but it takes some effort and creativity.

So, now that I have convinced you to choose the career of your dreams here are some thoughts on the effort and creativity it will require.

Do not underestimate the importance of choosing a life partner who gets the soul inspiring nature of your career choice. He/She may be another surgeon, or physician in another specialty, or a non-medical professional, or a skilled laborer; it doesn’t matter as long as your life partner understands that, when you are tired from the long days and nights, or sorrowful for the lost lives, or otherwise distracted, it is not because you love work more than you love them. Bottom line: as awesome as any career may be there is something messed up about your priorities if you really would choose work over loved ones. So your life partner needs to get that you aren’t messed up; you just have a demanding career.

With the demands of that career comes the need for a real partnership in planning life. That doesn’t mean a 50:50 split or a 80:20 split or anything conscribed; it means a constant openness to splitting however it needs to be split or not splitting at all to ensure that life outside of work happens. It means making the most of precious few waking moments together through physical contact and communication. It means having a very user friendly calendar/shared to-do system. It means providing feedback without judgment for the practical things in life and making space for shared emotional and spiritual needs. If you find yourself paired up with someone who can’t work with you on life this way, then consider dumping him/her. Seriously, it’s not worth trying to make them happy if they just don’t get this hugely important part of what makes you whole.

[NB: If a life partner is not your thing or things just don’t work out, that’s okay. The same principles of reimagining, outsourcing, and dropping the guilt apply. It’s just that your village, or metropolis as may be the case for some surgeons, has a different population structure.]

 

Choose your job based on both professional and personal needs. Training is finite and there is always an end from which to take on a new direction. However, even though many surgeons change jobs, think of your job as your forever job so you don’t accept a situation which will turn out to be toxic for you. Choose partners who will have your back, and you, in turn need to be willing to have theirs. Choose geography that at least satisfies some of your desires for commute time, distance from extended family, lifestyle, weather, etc. and makes life easier. You can’t blame surgery if your long commute destroys your soul, or if having your parents thousands of miles away makes you sad, or if humidity, piles of snow, or whatever your most dreaded weather phenomenon is drives you crazy, or if it takes a flight to get to your favorite past time of hiking, biking, skiing, etc. That’s on you and the choices you have made as a surgeon and not on the profession itself. Finally, choose a practice type and setting that will make you excited to show up every day (for me it was research, teaching, and a level 1 trauma center in a university based system).

If you do have a life partner and working is important to him/her, don’t pick a location that will railroad his/her career. As much as being a surgeon defines you, your soul mate is similarly defined. Please don’t create a situation where he/she will be susceptible to resentment about having his/her professional goals squashed. (I’ve been there. It puts a real strain on a marriage. It sucks.) It’s already hard enough to be paired up with you, a surgeon. Both your jobs may be equally demanding, or one may be more demanding; it doesn’t matter as long as together you negotiate a mutually satisfying life-long give and take about who prioritizes what and when depending on the stages of your respective careers and the ever evolving needs of your family.

When is comes to family, do not waste too much mental effort over-thinking when you should start it. Fertility, along with finding the right person with whom to test your fertility, is a complex and unpredictable thing. No pregnancy is guaranteed to proceed smoothly. Given these inherent limitations and unknowns, along with the demands of a surgical career, there is no perfect time to start a family. This is about as certain as death and taxes. I will spare you the perceived pros and cons to having children during training compared to while in practice. Just know that every time period poses challenges and every passing year makes infertility more likely; so if you are ready in your personal life to try to get pregnant go for it; because, if you choose to wait for a perfect time, you will be waiting for a very, very long time.

And, if having children in a traditional sense is not possible for whatever reason, there is also no perfect time for assisted reproduction, adoption, or surrogacy either even though the salary increase a staff surgeon or faculty job may be necessary for these options. In the end, whatever approach to becoming a parent will be required,  you will figure out a way to get through the challenges because you will have mentally and emotionally committed yourself to the idea of being a mother who also happens to be a surgeon.

[NB: If you choose to not have children-by this I really mean choose as there are myriad other mishaps of life and physiology that prevent women who want to be mothers from becoming mothers-, please do not make that choice simply because you want to succeed as a surgeon. You will never forgive yourself. Not ever.]

 

When it comes to family there are various options to manage childrearing and homemaking. A nanny, two nannies, an au pair, daycare, a nearby grandparent, a neighbor who is a stay-at-home parent, or various combinations of these may be required to keep your children loved and safe. It’s different for every family and I promise you that you will find what works for  you. It will be a source of stress but it is doable. And, no matter how much time others spend rearing your children on your behalf, those kids somehow know that your are their mother, that you love them in a way beyond any other love, that you would give your own life if it would save them, and that you also happen to be a busy surgeon. Trust me. They will. And, they will be really proud of the uniqueness of their surgeon mom. They really will.

When it comes to your home, be it your 600 sqft rental in residency or your 2500 sqft grown up home in a cul de sac, outsource any jobs you and/or your partner simply do not enjoy. I cannot emphasize this enough. You will, in fact, have precious little time with your family. Ask yourself how you want to spend that time. Do you want to being cleaning and doing laundry? Or do you want to plan a family outing? If hopping on your John Deere and showing your lawn whose boss on your Saturday off is a fun activity for you, then by all means go for it, otherwise someone else will be happy to mow your lawn for a fee. If you love cooking, knock yourself out planning, shopping for, and preparing gourmet meals along with the associated clean up, but if you don’t then find a meal service. You get the point. If you don’t love it and it can be done by someone else outsource it. Even on a trainee’s budget you should strive to rid yourself of any household obligations you abhor. (For me the $55 spent every other week during residency for cleaning was well worth never having to spend a day off cleaning a toilet and now the extra hours we pay our nanny to do all of our laundry has spared me a monthly power weekend of washing and folding 10 loads of laundry because we just could not get to it all with the many kids’ activities, call nights, etc. that prevent daily washing.)

Remember: as little time as you will have at home to spend with family, you must also prioritize time for yourself. Don’t expect it to just happen. Just as you schedule elective OR cases, you must schedule elective you time. It may not happen very often but if you don’t take the time for self care in the midst of the stresses of the job and the stresses of parenting you will be cranky and miserable to be around. How you spend time away from family when you have so little time with them will change over time and you may even develop hobbies incorporating your family (we have taken to family bike rides and kayaking trips as the kids have gotten older to combine wellness with family time) but remember to schedule things that feel completely selfish to you. A girls’ night, date night, a pedicure, reading a trashy novel, going to a Zumba class during bath/bedtime, or whatever you enjoy is totally not selfish but you will feel that way; so a good barometer for whether or not you are making time for self care is how selfish it feels. My advice is feel selfish at least once a month.

[NB: If your selfish thing is not a fitness thing then you have to also figure out how to fit that in because your patients and your family need you to be healthy.]

 

Being a surgeon is not incompatible with being a good wife, mother, athlete, whatever else; it’s just trickier. But, if young women keep being scared away from surgical careers then these same fears will linger generation after generation; we will never achieve a critical mass of women surgeons in the profession who can set good examples for one another and for future surgeons. With the same focus we apply in the OR and the same organization we bring to rounds and the same compassion we bring to patient encounters, we can create a life strategy that overcomes these perceived barriers for both a happy family life and a successful surgical career. The barriers will change depending on the stage of the career you love so much and the needs, wants, and development of what and who you love outside of work; but, take it from this surgeon mom: they are barriers to be overcome, not shied away from.

I am pretty sure that’s why you showed up at my door and asked me to that seminar, to make what seems impossible to you at the moment seem possible. Let me tell you: if I can do it, you can too. Go forth, be a surgeon, be a wife, be a mom, be good to yourself and craft a reality that works for you. Then, pay it forward so that someday these meetings and seminars might be rendered obsolete.

Sincerely,

@surgeoninheels

Not just a token surgeon-mom-wife-runner

PS. Here is some inspiration. Your potential in surgery is limitless. https://www.womensurgeons.org/in-practice/leaders-in-surgery/

PPS. The Association of Women Surgeons is an invaluable professional organization whose goal is to: ENGAGE current and future women surgeons to realize their professional and personal goals. EMPOWER women to succeed. EXCEL in those aspirations through mentorship, education and a networking community that promotes their contributions and achievements as students, surgeons and leaders. https://www.womensurgeons.org/

PPPS. I have been fortunate for the last 10+ years to be a part of the American College of Surgeons Women in Surgery Committee working towards improved gender parity, opportunities for professional development, and better work life integration in our careers. https://www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee

Getting Rid of the Guilt – Yes, it is possible.

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Guilt was not a huge part of my vocabulary until I became a mom.  (Well, if you take out my feelings about my occasional twinkie binge.)  Anyways, I never felt much guilt about how I spent my time.  Didn’t feel guilty about sleeping in… or working out… or having a girls’ night out.  And so on and so forth.

And then I became a mom.  You know, that moment when you get shoved into the most beautiful world – a place more beautiful than you could ever imagine… and then the door to your prior world gets slammed shut and padlocked behind you 😉

To be exact, I became a trauma surgeon mom.  A mom that can work in a week and a half what most Americans might work in a month.  I work crazy hours, am tired almost every single day, and typically I get only one weekend off a month.  Nope, no pity party here.  I chose it and I love it.  But, as I mentioned in the recent Forbes article, try as I might, I just can’t seem to find more than 24 hours in a day.  So what all this means is that it often requires pretty creative scheduling to keep my sanity.  Occasionally I try to arrange my schedule for a random day off, to take my kid to the zoo.  Or I might delay responding to some emails so I can go work out.

However, when I started this creative scheduling is when the guilt started creeping in… becoming a part of my mental vocabulary.  If I were running, I was thinking about all the work tasks I still needed to accomplish.  If I was at the zoo, I was worried about what my partners would think about my random Monday off.  If I was at work even when I really didn’t need to be, I felt like my family was, yet again, getting the short end of the stick.

The workouts stopped being enjoyable, my zoo time was colored by frequent email checking, and I just couldn’t totally relax and be in the moment, in any moment.  And that, my friends, is when it finally sank in… how my guilt was directly leading to my burnout.  In order to actually relax, restore, and repair myself, I need to be truly present and mindful.  Guilt will not let me be truly present or mindful, and I had to get rid of the guilt.

The moment you start feeling guilty about taking time to regenerate, is the moment that time stops regenerating you.

In fact, I was doubly screwing myself.  On paper, I was taking the time to exercise, or take my son to the zoo, or read a book.  However, I was not practicing mindfulness, or allowing myself to truly be present in those moments, allowing my mind and soul to relax, let go, and restore themselves.  Those thoughts of – well I could be doing this, or maybe I should be doing that – instead of fully focusing on whatever activity I was actually doing was completely counterproductive.

Let me ask you a question.

Have you ever felt guilty about brushing your teeth?

Okay, so why not?  Probably because you feel it is a necessity, something you have to do – to stay healthy and keep people from hating to be around you.  Well, why not try giving your restorative time the same respect?  And although I have heard more than one person tell me that “mom guilt” is a fact of life, an absolute, something to just accept, I am calling bull$hit.  Although feelings in of themselves are not necessarily a choice, we choose how we react to and acknowledge those feelings.  Once you fully understand and acknowledge that restorative time is important, you won’t be able to feel guilty about it.  Unless you feel guilty about the time it takes you to brush your teeth.  If that is the case, I really can’t help you… other than I know some great dentists.

So, my challenge for you today, heading into the weekend.

  1. Give your soul the same respect you do your teeth.
  2. Accept that you need TIME to participate in activities that make you whole.
  3. Give that TIME its deserved respect and value.

Go conquer your guilt and stay safe!

Allowing myself to just be deserves accolades, not guilt

I am always telling myself to not be one of those bloggers who gives a play by play of his or her day. I prefer to blog about fun things or things from which I derive meaning and I hardly think that anyone gives a rat’s ass about what I did and when so fair warning:

THIS IS A POST ABOUT WHAT I DID YESTERDAY.

I woke up even earlier that I do when I feigning to be morning exercise person to get my daughter to a 6:30am arrival for a field hockey tournament 70 miles away. 4am is brutal for mom, for the tween player who now routinely sleeps until 10 or 11am on weekends, and for the sad sap of an 8 year old brother who needs to tag along since dad is away on a much needed and well deserved guys’ weekend. Of course I am chronically fatigued and it’s nice now that the kids are older that I can use the weekends to catch up on sleep. So to have this privilege stolen from me for a sporting event deeply hurt me but parenting wins so there I was driving 1 hour and 20 minutes each way. The kids both slept in the car both ways. I jacked myself up with caffeine hoping not to become a statistic we trauma surgeons like to study on driving and fatigue.

When we got finally got home at midday I was exhausted. Despite the caffeine coursing through my veins I could not keep my eyes open so I stumbled into a sleep on our ever so cozy sectional. But it was a broken sleep. I refused to simply go up to the bedroom and just give in completely to the tiredness. Nope, I kept hoping that I would soon rise and have a productive day. You see, after several years of working on work-life integration, I am still having a hard time with simply relaxing. I am so trained to think of it as lazy and unproductive that when I do nothing in particular (or choose to sleep rather than doing) I feel an enormous sense of guilt and failure.

In between my fits and spurts of sleep I was thinking:

The house is a mess. (I should be tidying up!)

There are multiple loads of laundry to be done. (I should be washing and folding!)

The kids are somewhere in this house fighting boredom. (I should be playing with them!)

The work to-do list is out of control. (I should be tackling whatever I can remotely!)

There are thank you cards to write. (I should be putting pen to Crane’s paper!)

The Kindle is filled with newly downloaded e-books. (I should be reading!)

My ass is getting fatter as I lay here and the sun is shining. (I should go out for a run!)

I woke up at dusk. I felt like kicking myself for these myriad failed opportunities to get stuff done, to be a better wife (who helps around the house every so often), to be a more engaged mother, to utilize any one of the 7 habits of highly effective people, to take care of myself.

Argh! The self-loathing was quick and sharp.

Later on, once the kids had made sure I ate and stayed hydrated (their dad has trained them well) and had headed to bed (after showering and reading to themselves)* I took the dog for a nice long walk feeling the need to pad the mere 1k steps I had accumulated up to that point since my daily target is 10k. It was a serene and beautiful night. There were no cars zipping by. No sound of Lifeflight that is frequently overhead. No other dog walkers even. Most lights in the neighborhood were off on the eve of returning to school after winter break.

As I was retelling myself all the failures of my day and tryinng to forgive myself, the peace and calm of the night got to me. It occurred to me that I surely deserved some peace and calm with all that I do day in and day out, at home and at work (okay, fine mostly at work!). It turns out that a perfectly calm and peaceful night was a fitting ending to a day of rest that I unintentionally engineered for myself despite all of my intentions (including with this blog) to take better care of myself. I deserved accolades and not self-flagellation. And so I tacked on 4k steps dropping a little more guilt with each stride, congratulating myself on a job well done, not for being lazy but for successfully allowing myself to just be. 

Today, I can see that it helped recharge me for the household chores, unending work obligations, needy family, and self-care that are still there today waiting for type A, get-the-job-done, me.

[*NB: It gets better as they age, I promise. I miss the cooing and burps and smiles of my babies but I sure do appreciate their self-sufficiency on these lazy, ummmmm restful, days.]

 

Can this child learn emotional awareness?

When I talk to surgeons and other trauma care providers about burnout, I tell them that the first step avoiding the emotional exhaustion, depersonalization, and a low sense of personal accomplishment characteristic of burnout is to be emotionally aware. I make my audience stare at an empty black slide and ponder their emotions to explore how those emotions are impacting their impression of their day, their reaction to my talk, their distractions.

By the end of the talk, most in the audience know that the surgeon who flips out and throws things in the OR is not emotionally aware. The surgeon who goes home and gets into a fight with his/her spouse over some totally minor household to-do item because he/she had a long day and someone died and the work to-do list is getting out of hand is not emotionally aware. The surgeon who turns to alcohol or drugs to get through his/her days/nights is not emotionally aware.

And it occurred to me, as I was still reeling from and strategizing about what to do about our son’s recent behavioral issues, that my 8 year old has no emotional awareness. Whether it’s about brushing his teeth before going to bed, or wearing long pants when the temperature is below freezing, or losing a board game to his sister, anger and frustration drive his immediate response. Though the response is the opposite when he is excited about something, the effect is the same. His boisterous enthusiasm about getting picked to use the iPad in class, or lining up to see the neighborhood haunted house, or getting the gift on the top of his wish list under the tree on Christmas morning results in disrespectful acting out.

Whether he behaves like an angry petulant child or a boisterous obstreperous child, his emotions, in the absence of any emotional awareness, are driving him. I say “he behaves” rather than “he is” because I am convinced that he’s a balanced kid on the inside. He just needs to become emotionally aware and behave in a way that is safer and more socially acceptable. So here is what we have done as parents to move toward a more emotionally aware child.

We don’t ignore the minor transgressions. It’s easy as parents to zone out on the cacophony of kids. But now, when we hear a cupboard slam (because his favorite cereal is out) or perceive a wrecking ball to a lego structure (because it just wasn’t coming together the way he wants), we remind him that this is the kind of behavior we are now discouraging. If he learns to manage his emotions with the little things, he will be more like to do it with the big things.

We are talking a lot more about feelings. When he acts out or appears as if he is about the act out, we bring him to a full stop and have him verbalize what he is feeling, what is driving him. Often he does not know, but having him pause is helpful. And if he can put his finger on it, giving him the chance to bounce his feelings off of us validates his emotions while reigning in his destructive responses.

Now that he is aware that he has a physical response when he is frustrated or disappointed or angry he can work on ways to contain he outward behaviors. We have taught him how to slow down and take deep cleansing breaths when he feels his emotions getting the best of him. If we are near, his slow deep breathes are enveloped by a giant loving bear hug. If we are far, he squeezes a stress ball which he can find in his back back, or desk at school, or in various places in our home.

While these reactions in the moment are important, our son needs to learn a more constant sense of emotional awareness. Therefore, we are finding calming activities which had been increasingly absent as he grew into boyhood. My son now spends much more time coloring “adult” coloring books, working through origami, sewing, crocheting, balloon sculptures, and gimping. He was forced into these activities nearly full time during a 34 day period of “house arrest” following his misbehavior on the eve of Halloween. Putting his hands to work in a quiet, non-competitive way has been incredibly effective in allowing him to remain calmer, more centered, more contemplative when his is back to playing with his buddies.

Meanwhile, our newest adjust is practicing mindfulness and meditation via several apps we are currently sampling. It’s been 3 months since the epic transgression leading to our son’s loss of Trick or Treating. We are proud of his progress so far. We are proud of our progress as parents of a child who can, in fact, learn emotional awareness.

We are simultaneously monitoring our own emotional awareness with higher acuity. Whether the stressors are at work, or from a spousal disagreement, or related to raising an 8 year old, we are hyperaware that how we manifest our anger or frustrations influences what our child feels is acceptable. Therefore, we are challenging ourselves more than ever before not to fly off the handle but rather to be the kind of emotionally aware, present parents our rambunctious young man deserves.

 

 

Sometimes being a parent is hard (aka we took away trick or treating)

I am sitting here on a plane crying. I just don’t feel like leaving my son today. 

He is 8 years old. He is generally a good child. He does well in school. He devours books. He enjoys math. He is just as likely to break into dance as he is to play.  He is obsessed with all sports and loves memorizing stats and reading biographies of famous athletes past and present. 

He studied every detail of Roberto Clemente’s life story and picked this as his Halloween costume. He was so excited for weeks as each piece of the costume arrived. 

My son is outgoing  and has always been the boisterous one in the crowd. He has lots of friends. So of course he was over the moon excited to go out with them in his costume last night. 

Whatever our criticisms of Halloween may be (it’s a made up holiday, it encourages unhealthy eating, it exemplifies our society’s socioeconomic divides, getting dressed up in costume is just stupid…) the thrill of kids on this day (before they hit the sugar feuled meltdown anyway) is a joy for parents to witness. 

And last night my husband and I had to deny my son that experience. He will grow up some day and may read this and so I will be purposely vague on details here. And I know he already feels so bad.  But, suffice it to say that his behavior the last few weeks in terms of respecting others has been deficient. The poor boy feels terrible afterward each incident buy can’t seem stop it from happening in the first place. We have had three episodes of disrespectful behavior in as many weeks. 

Despite his obvious remorse for his most recent transgression, we couldn’t just let life go on as usual. He needed to be sternly punished. So we took away trick or treating. He sobbed in his room for hours leading up to the evening. He paced the yard while all the other kids came to trick or treat at our door. It was a tough night for him though he finally did settle down to enjoy a neighborhood party we hosted afterwards. Still the heartbreak in his eyes when the other kids were trading their candy was hard to witness. 

It was so hard to stick to our guns yesterday.  And today, when I walked by his open door and saw his uncovered pillow since he had taken off the pillow case first thing yesterday morning for his candy bag, I just lost it. Now I was the one sobbing while he was calm and introspective this morning. 

Today, he did not seem mad at us anymore. He expressed understanding of why we did what we did and what he needs to work on in the coming days, weeks, and months to regain our trust. But my heart was still breaking for having robbed him of that stupid made up experience that would have made him fat and rotted his teeth. 

It was an appropriate punishment but I still feel awful. As I fly away with the poor guy in seat 21B wondering why I am sobbing, I feel awful that my typically rambunctious yet sweet boy is acting out. I feel worse that I won’t be spending the next few days with him to help him sort through his feelings and strategize about how to behave better from now on.   

Whatever parenting pride I had yesterday that we stuck to our guns and rendered a swift and appropriate punishment is gone now, replaced by the emotional pain of a really hard moment in tough love parenting. Hoping this feeling and my son’s misbehavior will be a thing of the past soon.  

  

Musings of a Surgeon Mom with a Febrile Child

Oh poor thing. She has a fever. Look at her. Wet rag curled up on the couch already because she was too congested to sleep while supine. 

Yikes. I contemplate regular life in medical terms. Did that happen?!

Crap! It’s 6:30AM. I am already late for work. Ugh. Why did a choose a career that will forever me no sleeping in?!

But I should probably acknowledge my poor sweet sick baby before a run out.

Huh? Interesting the fever has knocked the tween angst right out of her. No attitude whatsoever. Just a sweet but needy girl.

{feeling her forehead}

Oh no. She’s on fire. Brain is probably too hot to mount an attitude. Now I feel bad for liking her lack of attitude for that moment.

I should probably take her temp. Wow this infrared thing is so cool! I wish they had this when I was a kid. I hated keeping quiet with a thermometer under my tongue.

Keeping quiet is not one of my strengths which paradoxically might have ended up being a strength in my career.

Eek. Her temp is 103.7. What’s that in Celsius again? I can’t actually process information in Farenheit anymore. It must be close to 39. 

Anyway, I should engage with my sick child before I tend to that career. Maybe she needs some anti-pyretics. Thank god we know about Reye’s Syndrome now. I am sure I took aspirin as a kid.

Whatever. I am an adult surgeon. Why am I thinking of Reye’s Syndrome right now? We don’t even have any ASA in the house. Thankfully no one is old enough and our arteries are presumably clean enough to hold off on cardio protection for the moment. 

“Hey. How are you feeling?”

“Awful.”

“Where does it hurt?”

“Everywhere.”

Crap. I hate viral fevers. Right lower quadrant pain and I could help my baby. There would be a clear solution and in a day or two she would be as good as new. 

I was about the same age when my appy came out. I have a gigantic scar now what with the hypertrophic scar tissue and the pregnancies stretching my skill. Damn babies. She has lighter skin than I do so maybe it won’t happen to her. And she’d have a much smaller scar now since there is laparoscopy. 

But it doesn’t matter since clearly she does not have an appy. I do love doing appys. Such fun little cases for the most. People typically feel better after surgery than worse. Definitely feel good surgery. 

But no my kid can’t be fixed with surgery today. Instead she has that full body malaise that comes with viral fevers. That I have been hit by a truck feeling. 

Well, actually come to think of it, I fix people who have been hit by trucks too. No help here too. 

So bummed. Cannot fix my sad, to sick to mount an attitude kid today. 

And, I can’t even stay with her today.  Nope instead I need to run out that door to tend to other humans instead of tending the one I gestated for well over 9 months. Yeah. She was giving me tween push back from the womb in retrospect. 

It’s a good thing I have a dedicated lead parent to snuggle her today. To call the school today. To tell his boss he can’t make it in because his child is ill. 

Not something I can do today. Or tomorrow.  Or any day this week. 

Crap I better not get sick now that I touched her. I cannot get sick. Not this week. Too much to do. I am on call. It will be a disaster if I have to work in viral turmoil. Sure I have rounded and operated with IVs in and snuggled with biohazard bags and emesis basins in between trauma activations. But really this week I need not acquire this viral illness. I. Just. Can. Not. 

Crap I am late. 

“Bye. I love you. I’ll see you in a couple of days.”

{A tear runs down my right cheek.}

Lead parent sent me this photo of her later in the day. Still on the couch. Finally able to snooze. My poor sick baby who I didn’t help today. 

 

My Kids Have Hijacked My Weekends

There is a high level alert going on in our household these days. What’s terrorizing me, you ask?

My kids’ activities.

I recall the time BK (before kids) when my time off of work was my time. Time to plan and to do (or to not). Sometimes I just spent all day in my pjs if I was lucky enough to have a weekend off. No agenda. Just a day away from the frenetic pace that  was the hallmark of my day job (and my night job and my weekend job!).

IMG_4007Then came the kids. Okay, it was work when they were infants. They had to be fed and diapered and generally kept alive. But their needs were simple and if I didn’t need to be in to be at work on a Sunday, I could sip a cup of coffee and read the Times while the baby (and later the toddler and the baby) were in my proximity. I kept them from sticking a fork in an outlet but essentially got IMG_4006to do my own, grown-up thing that made me happy. And when everyone was old enough, I was even lucky enough to sleep past 8am–a true luxury for a surgeon.

No longer true. Every weekend is now consumed by my kids activities.

Whether it’s 8am baseball practice or a 9am Field Hockey tournament over an hour away, forget sleeping in even though no one is awaiting a soggy overnight diaper change. Then mid-day rolls around and there is likely a dance show, a classmate’s birthday party, and another practice that vie for my kids’ time. And they don’t drive yet.

IMG_3530

IMG_3656We are forced to divide and conquer (thus separating me from my awesome husband who I actually like to spend time with when I am off). We are forced to eat in the car on the run when there just isn’t enough time between activities to sit down to a meal. We guzzle gallons upon gallons of gas going to and fro from event to event, some of which are on opposite sides of the state.

I can’t remember the last time I had an unscheduled weekend for myself. I struggle trying find time to get together with friends who are experiencing the same level of terror in their homes. I literally have gone years without seeing friends who live in the same very small state because with our kids we just don’t have time to be with anyone else on the weekends. In fact, I was so pleased with myself heading into this weekend. I managed to arrange both a work outing on Friday and a Sunday BBQ with my Ragnar van mates. I planned this as soon as the call schedule came out. And wouldn’t you know, out comes the email that the make-up baseball game starts a half hour before the work event and the playoff coincides exactly with Ragnar reunion.

Aaaaaaaaaargh!

My kids have hijacked my weekends and it’s infuriating. I want to support their interests (trust me I’m no Tiger mom; other than encouraging physical activity and retaining some cultural interests these kids a choosing to over-extend themselves with extra-curriculars and parties and playdates) but I can’t say I would shed a tear if they up and quit dance or ball or hockey.

Well maybe I would. If my kids end up too unidimensional to get into college then they’ll have nowhere to go after high school and I really need to get my weekends back.

7 Indisputable Facts for Moms of 7 Year-old Boys

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My little guy won’t be 7 much longer but here’s what I have learned in the past year about 7 year old boys.

Embed from Getty Images1) They don’t have an off switch. It’s constant full speed ahead until, of course, they spontaneously combust. For both the hyperactivity and the ensuing meltdowns, I suggest you invest in a good pair of ear plugs and an eye mask. There’s not point in fighting it and these tools will make you better at ignoring it.

Embed from Getty Images2) They have no fear. They will jump off of, charge into, ski down…, just about anything without consideration of the bones, ligaments, or internal organs at risk. The good news is, 7 year old boys are pretty resilient and most wounds at this age will heal without consequence. So enforce basic common sense and personal safety (e.g., helmets, no diving in shallow water, look both ways before charging forward) but let them wear their wounds like badges of honor.

3) They are always hot. They will wear shorts to school until December. In the middle of winter they will be shirt less when everyone else is clad in fleece. It will be -11 out (yes, that’s a minus sign and I don’t live in Antarctica) and they will refuse to wear a jacket. Be grateful for heated throws, Northface, and UGGs and just agree to disagree on the actual ambient temperature.

4) They love all sports. Even if you never encourage athleticism they will beg until they are blue in the face to do gymnastics, and football, and lacrosse, and skiing, and baseball, and karate, and soccer, and golf…. (You will wonder how they even learned about lacrosse.) Before you know it you will have committed all of your weekends for the next decade to your kid’s athletic pursuits so find a good family calendar.

Embed from Getty Images5) They know more about technology than you do. You may think you are savvy at limiting screen time but when your iPhone is on the futz they can fix it. If you want to rally for family movie night, you will have to rely on them to change the input on your AV system to Netflix. Oh well, you suck at IT but you may have future engineer on your hand.

Embed from Getty Images]6) They have fleeting interests (other than sports). Your dog will get a bowel obstruction from all the elastics that no longer are needed in that damn loom. You will realize the deep, searing pain of stepping on legos because all of those elaborate sets never make it back into their original boxes. You wonder is it Pokemon they are obsessed with or Minecraft… and one day you will find him doing Sudoku?! Well at least none of the above involve screen time.

Embed from Getty Images7) They don’t really want to snuggle anymore. They have too much kinetic energy to want to curl up with their mammas. They’d rather be doing something dangerous. They’re too hot to be tucked into your heated throw with you. You won’t be able to overcome the House Hunters vs. SportsCenter divide necessary for the TV watching snuggle. They are mad at you because in your technology errant ways you unintentionally offed one of their favorite tech toys. They are more interested in being big boys than little boys. You miss the old days.

And your heart breaks just a little as that 8th birthday approaches. Sniff.