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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

A Surgeon’s Survivor’s Guilt

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My heart tells me I lost them.  My brain tells me I never had them to lose.

One of my mentors has said that all trauma surgeons have their own personal graveyard, filled with patients we couldn’t save, and families’ hearts left broken.  A truer statement has never been said, and this weekend, this trauma surgeon’s graveyard has increased yet again.

The feelings that accompany this increase are always varying and deep.

There is anger.  True wrath.  When the hell are we going to figure this out?  When are we going to stop shooting one another?!  When are we going to learn that drinking and driving can be deadly?!  When are we going to start respecting ourselves, our bodies, and one another?!  When are people going to stop paving a path of destruction for themselves and others that is wide and immeasurable?!

There is sadness.  Sadness over the pain and the fear that my patients surely felt.  Sadness over the waste of life that we witness.  Sadness for the families left behind, in a new world they never anticipated.

And yes, guilt.  Guilt over being able to go home, when our patient couldn’t.  Guilt for leaving the hospital to enjoy my family knowing another family has just been destroyed.

This weekend was a particularly rough one for myself, and the hospital at which I work.  Although to most people around the country, it was just another act of violence, to myself and our community, it was felt deeply.  Every person in our hospital was stung, upset, and shocked.  Everyone knew what happened – I received touches on the arm, knowing hugs, and reassuring smiles.  They knew I did everything humanly possible even when the inhuman was needed, but that knowledge is a poor salve against this type of wound.

So please, if you know someone who works in healthcare – give them a hug, a high five, or even a thank you.  I have said before how we all take you, our patients and communities, home with us at night, but please also know that our lives are never the same either.  Every patient encounter alters us – sometimes subtly, and sometimes drastically.  We are changed, and we never forget.

Stay safe.

Mourning a Profession

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This past week, an unimaginable tragedy fell upon a family. A wife lost her husband. (Nearly) four children lost their father. A mother and father lost a son.

Upon a circle of friends. A group of buddies lost their companion. A band lost their guitarist. A neighborhood lost the guy next door. A congregation lost their fellow worshiper.

Upon a highly skilled cardiac team. These heart surgeons, anesthesiologists, cardiologists, perfusionists, nurses, technicians, and many more team members lost both a colleague and a friend.

Upon a hospital. These employees across roles and specialties lost a visionary among them, slain in their own halls.

Upon current and future patients. These vulnerable humans lost someone who just might have saved their lives.

Upon a profession…

I did not personally know Dr. Michael J. Davidson, a cardiac surgeon from Brigham & Women’s Hospital in Boston who was shot dead by the son of a deceased patient, but of course the degrees of separation are few in our educational backgrounds and our chosen profession. Still, I am arguably low on this list of people mourning, grappling with the soul sucking grief of an utterly inexplicable loss of life. But I am feeling it nonetheless. I sobbed listening to the excerpts of the funeral on NPR yesterday. Sat in my car and sobbed after a long day at the hospital.

As a surgeon, I am prepared for a certain amount of risk in my profession. There are communicable diseases. I always double glove, never making judgment on a patient’s risk of Hepatitis or HIV. I am tested for TB annually. I take countless precautions everyday to protect myself (and my patients) from the spread of infectious disease. There are ergonomic risks. I woke up everyday for ten years with back pain. Luckily I was able to fix many of my issues with pilates but many a colleague has required surgery after years of contortion about the OR table. There are psychiatric risks. Rates of burnout are high in my profession. Burnt out surgeons have high rates of clinical depression, substance abuse, and suicide. One study showed the the highest rates of suicide were among young female trauma surgeons with children. That was a sobering statistic.

When I get asked by aspiring physicians, and particularly by medical students considering surgery, why I do what I do, my truly heartfelt answer has always been “Because I get to save lives and to experience the bittersweet joy of a family saying ‘thank you for trying’ even when a life is lost.”

I have lost many a patient. And I have never, not once, before this week, felt unsafe after losing a patient. Not once.

I am on call today. I have already had a patient die despite my best efforts.

And so I mourn. And I sob. For all those people on the list above me who knew Dr. Michael J. Davidson and are experiencing unimaginable grief. And I also mourn for the loss security of my profession, a profession I chose to help others in their darkest moments. I am left in one of the darkest moments of my career.

Top 8 Reasons My MommyDoc Rocks!

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8) Some mommies wear yoga pants, my mommy wears scrubs. More cost effective than Athleta. Less see through than Lulu.

7) I always have a pro to go to for help with my homework. After all, she had to ace test after test to get into med school. And, she studies hard even now to maintain certification.

6) She’s taught me to suck it up. To quote “Unless there’s visible brain matter don’t cry!” I think this is because, in the absence of head injury, there were no days off during her many years of medical training.

5) But, for minor boo boos she always has a stick of dermabond handy to mend my wounds. Hours in urgent care purgatory thus avoided.

4) No episodes of Grey’s Anatomy wasting space on the DVR. Because you know, like she says “That *stuff* ain’t real!”

3) She doesn’t over think the parenting advice out there. She doesn’t have time to. So if I need a little screen time to give her a chance to to rest I get screen time. If I need to stay up late to get a chance to see her I get to stay up late. If I need toilet water…. There are no rules to MommyDoc parenting.

2) She understands science. So, I am up to date on all my vaccines.

1) She is a great role model. I know she feels guilty that she spends less time with me than other mommies spend with their kiddos. I hope she doesn’t get sucked into the mommy wars because those kids don’t have her to look up to.

Why everyone needs a wife.

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Last week, my FaceBook status read, “I really, really need a wife.”

For those of you that don’t know me, I am a woman, married to a man.  No, I am not trying to spice up our love life, and I have not changed my sexual preference.  I am, in fact, a wife myself… in addition to being a mother and a full time academic trauma surgeon.

Two weeks ago, as I was sitting in my office trying to coordinate the schedules for my 3 nannies, arrange for the repair of our hot water heater, and prepare a manuscript about pulmonary embolism while taking trauma call, one of my partners walked in while on the phone with his wife.  She was out running errands, and wanted to know if he needed more undershirts or socks for work.  May sound little to some of you but me?  I just sat there… dumbfounded and jealous.  Here was a person who was #1 – out running errands for the family and #2 – anticipating the needs of another.  In other words, she was working to make her husband’s life easier.

These past two weeks have been crazy, to say the least.  Managing a trauma service with over 50 patients, a manuscript deadline, a broken water heater, a broken clothes dryer, a bathroom leaking through a ceiling, a 2 year old, a nanny who quit halfway through a 36 hour call, and, oh, did I mention my husband is in law school 2 and a half hours away and only home on weekends?  Hello, Tums, meet my new gray hair.

Anyways, I flashed back to a zoo trip that I had with the aforementioned wife of my partner a few months ago.  She is college educated, has three ridiculously cute daughters, and successfully survived her husband’s overseas deployment and frequent moves with the Navy.  Did I mention she has some mad crafting skills?  In short, I admire her.  She is organized, hard working and has hobbies at which she excels.  However, during our zoo date with our toddlers on one of my rare during-the-week days off, she expressed to me that she often felt like people looked down on her as a stay at home mom/housewife.  Because she wasn’t doing “anything” with her life, her degree.  Implying that her current roles and responsibilities had no real world value or worth.

As I sat at my desk stressed, frustrated, and not just a bit overwhelmed, I saw and felt all the worth, the value, and the privilege of having a “wife”.  Someone to be there when it starts raining from the ceiling, to cuddle your child when he is sick, to remember to buy toilet paper so you don’t have to use Kleenex (ummm, totally hypothetically speaking, maybe), and pave the way for you to be the most successful you can be at work is no small thing.  It takes your life from drinking from a fire hydrant to drinking from a nice, perfectly cool water fountain.

I can’t even tell you how much I would have paid to have had a “wife” for the past two weeks.  That, my friends, is value.

And no, this person doesn’t necessarily have to be your legal female spouse in order to be a “wife”.  This person could be your husband, your mother, your best friend, and maybe even your non-stay at home wife.  Regardless of age, gender or legal status, this is the person who helps you live life a little easier… and this person is priceless.  Now, please do me a favor.  Go hug this person as soon as physically possible.  I am guessing they have no idea their true worth, and no one likes drinking from a fire hydrant.

Relax, Recharge, Reunite: Analysis of a Girls’ Getaway

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I am just heading home from a 4 day weekend with some of my college roommates. We have now known each other for longer than we hadn’t before we met in our late teens. As our 40th birthdays were approaching a couple of years ago, I suggested that we all get together to celebrate sometime this summer. After multiple Google searches for ‘girls’ weekend,’ many destinations proposed and rejected, and several ‘anonymous’ doodle polls, four of us amazingly agreed on a time and place and pulled it off.

It was the first time since graduation that we met ‘just because.’ There was no wedding or baby shower, no reunion, no conveniently timed and located work meeting. We wanted to, and in retrospect needed to, just be together for the sake of reconnecting with women we hold dear in our hearts, who will forever share a piece of our soul even if the hustle and bustle life keep us largely apart and disconnected from each others’ daily lives. We came together from different corners of the country. This is what friendship is all about.

So we friends, who have moved geographically and/or practically away from each other over the years, slipped right back into our easy friendship in a swank condo in downtown Denver. (Denver BTW is a great destination for a girls’ weekend offering a balance of outdoor adventures, culture, and urban fun but this blog post is not about that.) We laughed together. We cried together. We ran, hiked, biked, swam, and lifted/toned/burned* together. We shopped together. We relaxed together. We perused social media together. We ate and drank together.

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Mostly we just talked and talked and talked while we did all these things together. We had so much to catch up on: so much advice to seek; so many opinions to render; so many feelings to share. It’s not that none of us have equivalent friendships in our daily lives to do all this sharing, all this bearing of heart and soul; but the same challenges of life, be they work, kids, personal health, etc., that get in the way of us keeping in touch also get in the way of those local friendships.** Some of us, however, just don’t have women who are true friends close to our current homes, part of our daily lives. And for us, the reconnecting was ever so much more meaningful.

In theory, since we value each others’ friendship so much, we could call or text each other, we could Skype or Google Hangout together, and we could email or (gasp) send letters to one another to stay connected. But we don’t. We just don’t. It’s not that we don’t need or want to. We just aren’t able to execute on our friendships when everything else is a more immediate priority. So, without the rigors of daily life bearing down on us, without the distraction of some other event calling us together, we were able to just let go of all the things that keep us perpetually apart and be together this past weekend.

We all benefited. We felt unconditional love and received honest input on things that are weighing heavily on our minds. We learned more about ourselves and our relationships with others. We deduced what undergarments should and shouldn’t be worn and for what occasions. We exorcised demons of roommate fiascos of long ago. We built new memories and hatched ambitious plans for the future.

From gut busting guffaws, to smirks and smiles and frowns and tears, we had a great time. Part therapy, part fun, part vacation—girls’ getaways are an undeniable fact of life long friendships, quickly mitigating the challenges of distance and distractions of modern life. A perfect way to relax, recharge, and reunite.

*See Pure Barre

**This is why so many women who are in geographic proximity do ladies’ night out much in the way we did this weekend.

 

 

What you don’t know about your doctor

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I’ve been thinking about this post for awhile, and finally, am going to spill some “secrets” about me and my colleagues.

 

We are in debt.

I mean, real debt.  It actually costs most of us almost 1 million dollars to become your doctor.

 

It has taken us a long time to get here.

Let’s do some math.  4 years of college + 4 years of medical school + 5 years of surgery training + 2 years of fellowship = a long ass time and saying goodbye to my 20’s.  While my friends were off going to clubs, getting married and taking vacations, I was busy trying to learn about microbiology, genetics, and anatomy.  So, although we “appreciate” Jenny McCarthy’s medical degree from Google University, please listen to your real doctor.

 

We hate when you ask us when you can go smoke.  Um, duh, the answer is never.

 

Being a doctor is oftentimes like being a parent.

We have to have the hard conversations that can often lead you to not liking us… and, that is okay.  Yes, just like your mom tells you, “We are doing this because we care about you.”  Let’s face the facts, almost 70% of the United States is overweight or obese and that is not healthy.  This means, as the person who is supposed to care most about your health, we have to TALK to you about it.  Remember when you didn’t take your seizure medications and then wrecked your car?  Yes, we have to TALK about that.  You are addicted to your pain medication.  Yep, we have to TALK about that, too.

 

We joke about some pretty gross things.

Poop, snot, amniotic fluid.  Nothing is immune or off limits to our often very warped sense of humor.  If you happen to overhear us, you will probably think we are all a little crazy.  However, with what we see on the daily, we gotta find humor somewhere.

 

We make really good secretaries.

Ha!  Just kidding, I wish you could have seen my assistant’s face when I told her I was going to add this.  But, we do a ton of paperwork.  Out of a 12 hour workday, up to 4 of those hours will be devoted to writing notes, signing orders, filling out insurance paperwork, and returning phone calls.  Let’s do some more math.  40 patients in the hospital to see (which is an average for me) x 6 minutes to document the patient’s concerns, my physical exam, lab and/or radiology results, and my plan for that day = 4 hours.  Don’t forget to add in that I spend a large portion of my day in the operating room.  Unfortunately, there is this new found belief that if it isn’t documented, it didn’t happen.  All of these factors combined create an atmosphere that is paper centered, not patient centered… And we hate it.  We went through umpteen years of school and training (see above) to take care of you, not fill out forms.

 

Our families sacrifice so we can take care of yours.

I was on call the night my husband tore his biceps tendon in half.  I had to tell him to take ibuprofen, put ice on it, and try to not pick up our 18-month-old son until I could get home… the next day.  Although, our families understand this most of the time, it can still be hard on them… and us.

 

We take you home with us.

Like one of my own mentors recently stated, we do have our own cemeteries.  You may not remember the faceless doctor in the white coat who told you that we could not save your loved one.  But the pain, the anguish that we see in your eyes makes an imprint on our hearts.  There are patients that we never forget and days that we wish we could.  We see unimaginable horrors and yet have to press on.

 

And lastly, although we may have bad days and curse ourselves for choosing this sometimes tortured profession, we love what we do and care deeply about you, our patients.

An End to the Mommy Wars

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Recently actress Gwyneth Paltrow apparently charged head on into the mommy wars with some rather incendiary statements about how hard it is for her to be a mom compared to, say, ordinary “office workers.” The volume of media attention to the backlash has at this point far exceeded the attention to the original interview. But it’s possible that the mommy warriors, myself included (because I was pretty miffed when I first read it), have misunderstood Gwynee’s cry for help. It’s hard to be a mom for her, and for the rest of us.

I know all too well the sometimes overwhelming mommy guilt that can accompany one’s career. For me, the guilt is most crushing when I am not actively caring for patients. It is the sweetest thing that my little girl forgives me for not being home a lot because I am “helping people.” But in reality, when I am away from my children catching up on billing/coding or writing manuscripts/grants–or worse yet leaving town for professional meetings where patients aren’t even in the building–I am decidedly not helping sick people (at least not directly). While I do hope that my various efforts (fine, not the billing/coding which is simply an onerous task required of me in our messed up healthcare system–Argh!) will eventually result in better quality of care for surgical patients far and wide, the truth is that no human would suffer if I simply dropped those non-clinical professional activities in favor of being with my kids.

So it is a bittersweet cocktail of pride in being the kind of professional that I hope will someday inspire my kids and of guilt about achieving those professional goals at the expense of time with them. I know, I know, it is not the quantity of time but the quality of it. That said, there is always that dream of a guilt ridden mom that it is possible to make every minute spent with your children, whether it is 24/7 or just a few hours a week (as has been the case for me for the last decade), just awesome. No tantrums over broccoli.  No bribing with screen time. No imprint of your child’s teeth in another child’s flesh. No consumption of toilet water. No vomit in your hair….

Yeah no, that is just a dream. An impossible dream. Parenting has its ups and downs for all moms (and dads). Don’t believe anyone who denies it. Embed from Getty Images

For most of us, our life with our kids is the only ‘life with our kids’ that we have ever known. Clearly that is the case with Gwyneth Paltrow. And so it is hard for her sometimes to the only kind of mom she has ever been–a mom who is a successful actress whilst married (at least until recently) to a rock star. I can’t relate to 14 hour days on set with few financial limitations to excellent child care any more than I can relate to being at home all day, every day, without adult interaction with a needy child and piles of laundry that aren’t going wash and fold themselves. But, I do know what it’s like to work 120 hours in a single week, to be out of town for 15 days a month, to have my entire paycheck swallowed by childcare expenses and student loan payments, to be so damn tired (or so worried about a sick patient who might not make it through the night while I am at home) that, when I do get in the vicinity of my kids, all I want is for them (and the dog for that matter) to “Just shut up!!!!!” Embed from Getty Images

Yeah, there’s no quality time to be had with me after a 40 hour stretch on call.

Here’s the thing. No matter who we are, how many kids we have, whether those kids are perfectly healthy or suffer from medical issues/developmental delays, whether we work or stay at home or do something in between, whatever our profession, we are all mothers. We are simply trying to do our best by our kids, and some days we will badger ourselves with mommy guilt for not attaining that. Failing to recognize that (as opposed to being seemingly ignorant of her wealth and privilege) is why Gwyneth Paltrow has become enemy number one at the front line of the mommy wars. She minimized, in a condescending almost pejorative way, the mothering challenges of moms with ‘regular work hours’ without having any clue as to what it must be like for them to balance it all.

Not cool Gwynee, not cool.

In the modern era, all of us mothers have had to make some tough choices when it comes to focusing on ourselves whether it is personal well being (e.g. that which is reaped by way of long runs, weekends away with friends or spouses, a Nordstrom shoe habit) or professional aspirations. For some, the latter has involved a conscious and deeply individual decision to stay at home full time after weighing many complex factors such as income, job satisfaction, availability of professional childcare, family support, presence of life partner…. For others who have weighed the exact same issues, it has meant going ‘all in’ to professional ambitions.

I did not fall into the latter by accident.  My academic and extra-institutional activities have been bolstered by the support of a truly self-less spouse, amazing grandparents in very close proximity to my children, a boss who gets it, and a salary that allows me to support my family. (I think Sheryl Sandberg would say that I have been ‘leaning in’ but I confess between the work, and the wellness efforts, and the blogging, and the travel I haven’t read a book in a while.) And Gwyneth Paltrow, it seems, has decided to act in fewer films.

The trade-off(s) for her decision may be fewer chances to get another Academy Award or less time with the likes of Matt Damon. But I submit that there is not a single mother out there who has not had to negotiate away some aspect of herself in order to be the best mom she can be. And, I bet there is not a single mother out there who hasn’t at one point or another thought that her plight as a mom is much harder than that of anyone else’s. I know I have. I just wasn’t in a position to share it with a major media outlet.

Think before you speak, Gwynee. Think before you speak.

An so, what has really struck me as I have read about the mommy wars that ensued in the aftermath of this now infamous interview is that all of us moms would be better served if we propped each other up instead of putting each other down. Our sources of mommy guilt may be the same (which is abundantly clear to me whenever I commiserate with other surgeon moms, especially the traumamamas whose call schedules are particularly unforgiving), or they may be different.

Irrespective of the source of guilt, the reason we are ALL so prone to it is because, after all, we are all MOMS. We are torn between focusing on ourselves at the expense of our kids. We are afraid of what the future holds for them and how what we do (or don’t do) now will shape that future. We too easily question whether we are cut out to be mothers when things seem bad at home or at school or at the myriad activities our kids participate in these days. Rather than judging whose mommy guilt is more overwhelming than the other’s, we should embrace these similarities among us and encourage each other to drop the guilt no matter where is comes from.

Perhaps if we consciously uncouple ourselves from the bitchiness, we can reach also reach an easy truce to the mommy wars.