What I’ve been up to

Applications in. Lots of them. Interview invites. Not enough of them. Abstracts in. Four of them, to two conferences. Presentation done at one conference, and one pending for another. Rotations down. Three of them. Election pending, with women’s health issues cropping up frequently. Z had a birthday. I had to put a cat down.

So what prompts me to break my blogging fast?

Being a snarky know it all on Facebook.

I wrote about it on Mothers in Medicine. Go check it out.

Match registration

The NRMP match registration is this Saturday. Here we go again.

Preventing primary cesarean

Hi! Internship has been keeping me busy. So has getting together my presentation for this year’s VBAC summit. I had an hour and fifteen minutes to talk. I went over, and I still didn’t cover half of what I wanted to say.

The First Cut is the Deepest. (I can’t figure out how to embed the viewer.)

You can find the mp3 to hear me speaking to go along with the presentation. I explain. A lot. I also tell funny stories, horrible jokes, and pass out chocolates. Sorry, the chocolates are not available through the internet.

MP3 of me: https://www.wepay.com/stores/vbac-summit/item/preventing-primary-c-sections-what-you-need-to-kno-717302
MP3s of all of the presentations: https://www.wepay.com/stores/vbac-summit

“Life” as a single mom in internship

It’s life, Jim, but not as we know it…

I am blowing the cobwebs off of the blog once again. I have a rare moment to write. Well, it’s not like I don’t have a lot of other things I could or should be doing, but I can’t pass up this quiet pause.

I am just over two weeks into my intern year. I am doing a traditional rotating internship at a local hospital. I volunteered to be on nights first. For the night float, I am working 6 nights a week, and an average of about 10 hours a night. Our team does admissions into the hospital from the ER, handles house calls, and helps run rapid response codes and code blues. As busy and frustrating as the job can be, it is not horrible. I love the people I work with. We have a great team, and I really like the people in the graduate medical program in general.

I am happy because I have gotten to handle a few emergency night gynecology admissions for my favorite attending physician in the hospital, a gynecologic oncologist. I also have gotten to handle a few psych admissions. Psych is my second love. The other members of the team gladly let me handle these cases. I know what to do on a lot of basic house calls now. I got to help save a woman’s life, a patient who coded and ended up having a massive heart attack.

I am naturally nocturnal, so the nights thing isn’t killing me so much. It is really difficult to have a life outside of the night float, however. One of my sons is mostly traveling with his father, and my other son is in camp and is spending nights at his grandmother’s house. That is why I volunteered to do my 4 weeks of nights now. I try to see them every day that I can. Sometimes it is only for a brief visit, after I wake up and before I head in for my next shift. I have one day off a week. The last one I spent dozing off on the couch. I had to spend the day today at an excruciating orientation. I had to flip my schedule to days for two days in order to attend it. As my friend and fellow expert in scatolgical therapy told me, this kind of sleep deprivation would turn her into a “drooling turd sandwich”. I am officially there.

I am gearing up for the match again. I am not looking forward to going through the whole process again, except with less spare time and optimism. I am also facing the harsh reality of residency as a single mom, without the benefit of doing what I love – ob/gyn. So, the application process is especially horrible.

Today, after orientation, I stopped by to see an old friend whose brain cancer is, unfortunately, messing with him again. He is now suddenly mostly blind, and will find out soon if he will be having his fourth brain surgery, and will most likely be starting chemo again for the umpteenth time. I picked up the kids, and made it all the way to the grocery store parking lot. I looked around in my wallet and purse for a Visa gift card I had been saving for such rainy days. It is pouring, my friends. I am waiting for a check to clear, and a deposit to show up in my account. My cushion between the two is $10. I couldn’t find the Visa card, so I took the kids home.

When I got there, I was so emotionally, mentally and physically exhausted, I couldn’t even bear the thought of looking through my cluttered, dirty house for the gift card. I, luckily, am quite a food person. Even though I have not done a decent food shopping trip in more than a month, I have a kick ass pantry and reserves. I had defrosted catfish nuggets (yeah, mama is buying cheap) already, and had hoped to buy the ingredients for the beer batter today. I also haven’t had any bread for over a week, and I have to make breakfast tomorrow for the kids, and Seb needs a lunch for camp.

I put together a breading for the catfish out of flour, cornmeal and plain yogurt. I had vegetable oil for frying. I had half a bag of onions, so I made onion rings with the rest of the breading and oil. I also had half a packet of yeast, and just enough flour and milk to make dough for bread. After the kids and I ate the interesting, slightly tart but definitely edible dinner, I passed out on the couch at about 8 pm. I am officially a drooling turd sandwich, and am on the exact opposite schedule I need to be on to resume a stretch of seven night shits in a row as of tomorrow night.

I didn’t clean the kitchen, which was wrecked. I didn’t bake the bread. I didn’t dry the laundry, which included stuff that S needs for camp tomorrow. I did manage to wake up intermittently to tell the kids to shower and brush teeth. I got Z into bed, and eventually got myself from the couch into bed.

I woke up at 4 am. Initially I was annoyed, since, as I said, this is the exact opposite schedule I need to be on. But, now I am grateful. Even with only half a packet of yeast, the bread dough rose beautifully. I kneaded it and put it in the oven. I put the wet clothes in the dryer and started a new load of laundry. I tackled the oily, breading-y mess of a kitchen. I started a load of dishes, cleaned all the pots and pans, I swept the floor, wiped down the counters and some surfaces, and I am now on the couch, enjoying a cup of delicious coffee and the aroma of freshly baked bread.

S made me a pot of French press before he went to bed last night, and it was waiting, full and gorgeous, on the kitchen counter amid the oily mess this morning. It was quite a love letter from a thirteen year old. He and I share a love of French press. He offered to try to help me out, since my fancy coffee maker decided to finally die about a week into my internship, by making me pots of French press when he was home. But, we got in a big argument about it the other day. I was exhausted, he was feeling very thirteen and had been juggled from his grandma’s to his dad’s and then back to my house. We got in one of our worst arguments in a while over him making me a pot of coffee. It was the first hour I had seen him in three days (his dad had him for the whole weekend), it was the first time he had spent with his brother in a few weeks. We spent it fighting about him plunging the coffee, and he was reduced to tears. So, it meant a lot to me to wake up to a fresh, full pot waiting for me, unbidden.

So, the kids are still sleeping. The washer, dryer and dish washer are humming. The sun is coming up. My coffee cup is empty, and I am going to pour myself another love offering and I’m going to walk the dog to the lake and drink it and the sunrise in. The bread is cooling and will be ready to enjoy for breakfast. I may even get to my presentation for the VBAC Summit.

Could be worse.

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.

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?

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.