Monthly Archives: June 2012

Reply turned post, single mother in medicine style

I am a contributor at the wonderful site Mothers in Medicine, and this week a guest poster wrote in to ask Do Single Mothers Go to Medical School? Please go read her original post and the other comments. Here is my very long-winded reply:

Hi! I am a single mother who just finished medical school. I would be happy to chat with you through email, if you’re interested. Please feel free to let KC know, and she knows how to get ahold of me. Also, you can read the posts I have written on here (click on the MomTFH link in the labels to the right–>) or read my blog at http://momstinfoilhat.wordpress.com. Not all of my posts are about being a single mom, obviously, but it is my constant reality as I write. As I hope you have discovered, it is easier and harder to be a single mom than you may have expected, and it does not dominate all of my thoughts, conversations and interactions.

OK, on to your questions. Let’s start with the simpler one. I took the MCAT after being out of the basic science classes for several years, too. I used a single review book and did OK. I happen to be a good test taker. If I had a time machine (Oh, geez! the things I could fix!) I would have taken a review course and probably scored higher. I think taking a targeted MCAT review would be higher yield for you than retaking all of your premed. That will also take quite a while. But, if you think having domestic good grades will improve your chances of admission, it’s definitely an option.

As for RN vs. NP vs. being a physician, that is really up to you, and I don’t think there is an easy answer to that. There are many days in which I wish I had the time machine and could go back and be an NP, but I may be a unique case. I am older than you, I want to go into obstetrics, and I didn’t match into residency last year. If I was a nurse practitioner / midwife, I could be working already, no residency required, and be doing everything I want to do as a doctor (I am not super gung ho about being a lead surgeon and am more interested in low risk obstetrics, obviously, but there are plenty of NPs that assist in the OR, just don’t lead surgeries).

Obviously, yes, single mothers do go to medical school. I was pleasantly surprised at the diversity in my class. I sat next to a grandmother all of 2nd year, and I was not the only single mom in my class. Also, single mothers do a lot of things that take them away from their kid(s). Many single moms work outside the home for long hours and have to rely on different forms of help and childcare. And, most of these single moms are not pursuing a life long dream, one that will most likely provide financial security and a fulfilling career. Moms have guilt, single moms have guilt. I don’t let that keep me from pursuing my career in medicine.

Medical school is not a bad situation to be in as a single mom. Especially the first two years. There are many schools that even stream most of the classes online, and do not have an attendance policy for many of the classes (mine did). Your clinical years may be more difficult. Your schedule can change from month to month, and I have had to ask a caregiver to show up at my house at 4:30 am some months so I can get to my rotation on time. Even more difficult, my schedule would change in a month. My kids were in school and had after school care from a trusted family member, so my main issue was the early mornings.

As for being able to handle it, I was the president of more than one extracurricular club. I won a research fellowship and full tuition scholarship. I was recommended and inducted into the humanism honors society by one of my attendings / professors. I qualified for the regular honors society, but I won’t go into the political BS that kept me from that group. I aced my boards and never failed a class. I am not just tooting my horn here; I am telling you that, if you work hard and have the aptitude and right attitude, you will do well.

I have written on my blog about my sometimes frustration with some of my former classmates. These are things my single, childless classmates have told me: I gave up using any washable dishes or glasses during medical school because I don’t have time to do any dishes. I gave up my dog to my parents during board review because I can’t take care of it. I don’t have time to do _____ activity or ______ club. I didn’t have time to take the required scrub class before rotations started because I wanted to go on a vacation. I need to take off a month because I am planning a wedding. I can’t make the meeting at that time because that’s when I nap. (Yes, for real) I would see some of these same students go to yoga 3 times a week, or party frequently, or get their mani/pedi once a week, or watch every episode of the Jersey Shore, or make what ever bargains or compromises they chose. So do I. (Make compromises. I don’t do any of those things on the list. I have a dog and two cats, I cook and use real dishes and plates, and I don’t get to work out often if at all, watch much TV, or take care of my fingernails, hairdo or other beauty routines often. I also schedule my naps, rare as they are, around my obligations, not the other way around). So will you, compromise, that is, regardless of your path.

As for divorce, moving, family support – that stuff is not easy. If you email me and are up for it, I can regale you with the soap opera that was my divorce and coparenting (they don’t call it custody anymore) agreement, and the sacrifices I had to make to be able to move if I matched out of the area. Single parents relocate all the time for many reasons. It is not fair to expect every single parent to remain, forever, in a 50 mile radius of where they divorced. There are a lot of moving parts to this, and I could write more words than this entire post already (seriously not kidding) about it. A lot of this depends on your ex. This battle was infinitely harder than medical school for me.

Anyway, I hope this wasn’t too much, and was helpful in some way. Good luck, and please keep us up to date.

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Reply turned post, not ranting about pap frequency

I want to be Dr. P at The Blog That Ate Manhattan when I grow up. If you like my blog, you should love hers. She has been especially on fire, both with her cooking posts and her women’s health posts. Her blog has been in my sidebar forever. But, I can’t resist linking to her now and then, even when huge women’s health and politics related stories pile one on top of each other and don’t budge me to post.

She wrote about the new American Cancer Society cervical cancer screening recommendations on her blog here. She does an excellent job of breaking them down, and discussing their implications to both patients with different clinical histories and providers. Go read her post, and then I had a reply. Usually my reply – turned – posts are ranty, but this one is just guidelines wonk-y:

Your blog posts are always wonderful, and they have been especially informative and well researched recently. Thanks!

The ACOG / USPSTF recommendations currently say not to do HPV testing under age 30, as far as I know, even if the cytology is abnormal: http://www.acog.org/About_ACOG/Announcements/New_Cervical_Cancer_Screening_Recommendations

Am I correct that the ACS recommendation are slightly different? (Which is not unheard of, they are different when it comes to mammography initiation and frequency, for example.)

If these ACS recommendations accept a higher rate of cervical cancer in the 20 – 29 group, I wonder what the effect of reflexive HPV testing will have on cancer detection in that age group.

What do you think of scheduling annual appointments for bimanual exams and counseling? I think bimanuals are still recommended yearly. How would that work, practically?

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The flame challenge

I was watching a recent episode of the Colbert Report, and Alan Alda was the guest. I have been an Alan Alda fan since he was on the TV version of M*A*S*H as Hawkeye. Well, apparently Alan Alda not only played a questionable role model physician, but he is also really into science. He explained his idea, the Flame Challenge:

As a curious 11-year-old, Alan Alda asked his teacher, “What is a flame?” She replied: “It’s oxidation.” Alda went on to win fame as an actor and writer, became an advocate for clear communication of science, and helped found the Center for Communicating Science at Stony Brook University. He never stopped being curious, and he never forgot how disappointing that non-answer answer was.

So when he was invited to contribute a guest editorial to the journal Science, he wrote about why we need scientists to communicate clearly and vividly with the public. And he issued the Flame Challenge: I’d like to try a playful experiment. Would you be willing to have a go at writing your own explanation of what a flame is—one that an 11-year-old would find intelligible, maybe even fun? The Center for Communicating Science is looking for new ways to light up people’s minds with science, and you might point the way. We’ll try out the entries on real 11-year-olds and see which work best. . . .

So here I am—I’m 11 years old and looking up at you with the wide eyes of curiosity. What is a flame? What’s going on in there? What will you tell me?

I remember asking a science teacher to explain a flame to me when I was in junior high (that’s what we used to call middle school, kiddies), too! I was also disappointed in the answer I received: “It’s a chemical reaction.” Yeah, OK, but what IS it? Solid? Liquid? Gas?

The winner is a candidate for a Ph.D. in quantum physics who lives in Austria, but is from the United States. His name is Bill Ames. Here is his winning entry. His entry was chosen by eleven year olds.

There is more background information, and an adorable picture of Bill Ames and his daughter here.

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Reply turned post, from abortion to homebirth style

Hello! Hey, I’m a doctor!

Please go read this excellent article at RH Reality Check: Why Birthing Rights Matter to the Pro-Choice Movement.

Here is a great quote from the author Laura Guy, who is a doula (yay!) and a certified lactation consultant (IBCLC) (double yay!):

But let’s be clear about something. Reproductive justice means that everyone has complete control over if, when, where, how, and with whom they bring a child into the world. It means that people have accurate, unbiased access to information regarding all facets of their reproductive lives, from contraception to pregnancy options, from practices surrounding birth to parental rights. It means that our choices are not constrained by politics, financial barriers, or social pressure. In other words, how can the right to give birth at home – safely and legally – not be on a reproductive justice advocate’s radar?

As I commented on the article, I was thrilled when, during the keynote address at my first Medical Students for Choice meeting, the speaker mentioned out of hospital birth. Reproductive rights are full spectrum. They start before sexual activity begins – bodily autonomy begins with birth, stretches through childhood with protection from oversexualization, extends through accurate sexual education, includes contraception and freedom to choose when and how to become sexually active, and definitely doesn’t end once one decides to carry a pregnancy to term. The ability (or lack thereof) of women to choose the site and mode of their delivery, among other important issues of autonomy during pregnancy, are key ways that women’s rights are challenged daily in this country. Pregnant women are not human incubators.

So, seems like a bunch of mutual appreciation society activity here. Where is the angst that usually prompts the reply-turned-post? Well, on the RH Reality Check link of Facebook, one commenter says: “This is great and it’s also important for women to have the right to medical interventions (like elective C-sections) they feel are right for them.”

Here is my reply:

‎@Kathleen – within reason. Feeling something is right is one thing, but unnecessary medical intervention is not a “right” per se.

It’s a very nuanced issue that may not fit well in the comments section on Facebook. For example, evidence and expert position statements warn against early induction. Feeling like an induction is right is not enough of a reason to get one. Take it from someone who has been in the paper gown, sick of being pregnant, and in the white coat – many women feel like an induction before the end of pregnancy.

Also, someone who is a really poor candidate for vaginal delivery (placenta previa, for example), may feel like they want a vaginal delivery, but it is not medically advisable. Same goes for women who are poor candidates for homebirth. I think homebirth is an excellent option for good candidates. Not all. There is a role for practitioners to play here, too.

As a physician and most likely a future ob/gyn, I will be one of many practitioners who need to constantly work that balance between respecting a patient’s autonomy, providing good informed consent, and practicing good medicine with a good conscience. Medicine is more than ordering off a menu.

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