The 2017 marathon

I had a dream last night that I was running a marathon. At first glance, that might not sound pleasant, but it actually was. The running felt effortless, the weather was beautiful, people were cheering me on as I went, and I crossed the finish line to hugs and happy tears from family and friends. I woke feeling peaceful and content.

In many ways, this last year has felt like a marathon to me, but certainly not as pleasant as the one in my dream. Learning how to juggle motherhood and my career has been a balance that I struggled to find. Supporting our child through her health journey has also been physically and emotionally taxing. Yet as 2017 winds to a close, I can't help but reflect on the many positives along this marathon route. I was blessed by the family and friends who cheered us along the way and did share our celebrations with hugs and happy tears. My family is crossing the 2017 finish line intact and well. I can even look back on some career accomplishments in the last year with pride.

2018 feels full of possibilities. Maybe I actually will run that marathon;* more likely, I'll keep working at being the best family physician, teacher, writer, mother, and wife that I can be. I've never been someone before who sets resolutions, but I'm resolving to be more intentional about how I want to experience this next year. I have some goals, too, related to my personal writing and my faculty development interests that I'm pretty excited about.

Bring on 2018; I've got my running shoes ready.

* I've never actually run further than a 10k in my whole life. This particular dream is definitely a bucket list item for me. :)

Mother's Day 2017

My evening routine ends the same way every night - I tiptoe into my sleeping daughter's room for a final check and view of her for the day. 

Often, I'm coming from a brightly lit area, so it takes my eyes a minute to adjust until I can see her. I stand over her crib, blinking into the darkness, waiting for my pupils to dilate. After a few seconds, I can usually make out her hazy outline. A few more seconds, and the position of her limbs and head is more clear. Finally, I can see her in total, her back* rising and falling as she sleeps, usually with one hand curled up near her head and the other splayed out behind her. I stand there for a minute or two, and let the beauty of the moment consume me.

You'd never know, looking at her peacefully slumbering, what she's been through already. The surgeries, the physical therapy, the medications. You'd never know, frankly, to look at her during the day, as she alternates between joyful glee and serious exploration of her world. In the dark, these are not the thoughts that come as I watch her. That time, somehow, remains reserved for joy. She is resilience personified, and I'm so blessed to be her mother.

This Mother's Day, my first as a bonafide mother, is admittedly bittersweet as I ponder the years of infertility and loss that preceded it. But the gift that is our child provides more than enough sweetness to offset the bitter. And this evening, as I ponder her sleeping form before headed to sleep myself, I'll allow myself a moment again to let the gratitude wash over me.

* We put her to sleep on her back every night, but she's capable of rolling independently and thus safe to leave on her belly when she winds up there - which she does most every night now. But "back to sleep" for infants always!!!

Being the parent of a patient

Over the last few years, I've been frequently been the patient thanks to infertility. Being a patient who is also a doctor has certainly felt unsettling at times, but over the years I got used to it. I couldn't really ever turn off my doctor brain sitting on the exam table, but I tried to listen thoughtfully to my doctors and their recommendations. Infertility treatment involved a lot of discomfort and heartbreak, and over time dealing with those issues almost became routine. Normal.

Then my child had a serious medical issue requiring surgery. And everything I thought I knew about being "on the other side" went straight out the proverbial window.

I'm not going to describe her medical issues; I want that to be her story to tell, if and how she chooses, when she is older. She continues to receive excellent medical care, and I will be forever grateful to the many doctors, nurses, patient care techs, physical and occupational therapists (I'm sure I'm missing someone, but I'm ending the list here for brevity's sake!) who are caring for her. It's certainly true that her surgeries and care thereafter couldn't have gone better. Life is slowly starting to get back to whatever constitutes normal as a working physician parent.

And yet, I can't seem to get back to normal myself. The level of emotional fatigue that I'm still experiencing is outside of anything I've previously known. As much as I'd like to just sweep these feelings away and resume daily life, they don't seem interested in going anywhere. I wish they weren't as demanding of my energy, but they're definitely quite settled in.

Part of me feels like it would be a betrayal to all that has happened to just pick up and get back to "normal." Part of me is afraid to let go of the constant vigilance that accompanies having an ill child. Part of me is unsure that I'll recognize myself in the mirror if I dared to really look, now that we're hopefully through the worst of this experience.

So, for now, I'll just keep plodding along. Maybe this reality is destined to be my new normal; maybe these feelings have taken up permanent residence. I'm just going to allow them the space they need.

Their continued existence would certainly be a small price to pay for my child's well-being.

Inspiring family physicians on social media

In my last post, I mentioned "articulate and inspiring family physicians on social media." I thought I'd take a break from my current post arc and share who some of these amazing people are, both family docs and those who advocate for Family Medicine:

Dr. Mike Sevilla @drmikesevilla http://drmikesevilla.com/
Dr. Ranit Mishori @ranitmd
Dr. Andrew Morris-Singer @AMorrisSinger http://www.primarycareprogress.org/home
Ms. Molly Talley @mollytalley
Dr. Bich-May Nguygen @bicmay
Dr. Carla Ainsworth @SeattleFamilyMD
Dr. Pat Jonas @apjonas http://drsynonymous.blogspot.com/
Dr. Kenny Lin @kennylinafp http://commonsensemd.blogspot.com/
Dr. Mark Ryan @RichmondDoc
Dr. Jay Lee @familydocwonk
Dr. Jen Brull @mrsbrull
Dr. Kim Yu @drkkyu
Dr. Heather Paladine @paladineh
Dr. Emily Lu @dremilylu
Dr. Anne Montgomery @AnneMont
Dr. Glen Stream @grstream
Dr. Reid Blackwelder @blackweldermd
Dr. Robyn Liu @rliumd
Dr. JL Richardson @drjfpmd
Dr. Torian Easterling @KTEGlobalMD

Please check them out! If you're not on social media, please know that Twitter is more than the US president's rants and what your favorite celebrity ate for breakfast. There's a vibrant medical community on Twitter that's well worth a few minutes of your day.

I am 100% sure that I have missed some worthy individuals, so please add them in the comments section below.

My baby's doctor is not a pediatrician

"Who is your baby's pediatrician?"

I was first asked this question 12 weeks into my pregnancy by my OB's intake nurse. I have since been asked it countless times - when I arrived at the hospital for my delivery, as we were leaving the hospital with our new baby, and then every time we have taken her to specialist appointments and hospital admissions over the last few months.

My response has been the same every time: "Our family doctor is..."

I don't think any of the people asking me this question intended any offense. I know that, for many people, "pediatrician" = "doctor who cares for children." And, yes, pediatricians are doctors who care for children.* But family doctors care for children, too. The automatic assumption that my baby's doctor is a pediatrician is part of the image problem that Family Medicine still has. It seems that most of the lay public - and, frankly, much of the larger medical community as well - still doesn't know who we are and what we are qualified to do as family physicians.

I've written about this issue before, but nothing has changed regarding our national specialty organizations' efforts in the last four years. Certainly there are many articulate and inspiring family physicians active on social media, but that channel reaches only a relatively small segment of both the medical community and the lay public.

The US will not achieve an accessible, high-functioning healthcare system that delivers equitable, high-quality care without Family Medicine as its foundation. If people don't know who we are and what we have to offer as a specialty, if people don't know that family physicians' patients live longer and better at less cost, how can we possibly be a part of the national conversation about healthcare?

Maybe each of us, as family physicians, needs to launch our own mini-public-relations campaign. First and foremost, our patients must know that we are family doctors (not just a "general practitioner" or a "PCP"). We need to get involved in local medical organizations and make sure primary care's voice is heard there. We need to share our passion for our specialty with anyone who will listen.

I will start by affirming that my baby has a family doctor.


* Pediatrics is a specialty with board certification and its own rigorous training. I suspect many pediatricians would take some offense at the assumption that any doctor who cares for children is automatically a pediatrician. For the record, I have nothing but the utmost respect for pediatricians.

Pregnancy after infertility and loss

I just about stopped writing while I was pregnant last year. Sure, I kept writing professionally. But this blog, and the fiction I had been working on - nothing. Nothing for 9 months. I didn't mention my pregnancy on the blog, and I barely did so on other social media channels.

When I think back to why that might have been, I remember that writing requires recognizing the truths within yourself. There was a truth within me that I did not want to face during my pregnancy; I was terrified that I would lose my baby. I am a board-certified family physician and intellectually knew better, especially once we passed the first trimester. But I did not trust my body to care for my baby. I kept waiting, day after day, for something bad to happen. Once it was obvious I was pregnant, family, co-workers, and even patients gushed with happiness for me. I tried to match their jubilant tone, but it was always fake. I had trouble bonding with my unborn baby and resented the discomforts of pregnancy.

I can't blame you for thinking that the above paragraph sounds impossibly irrational. Looking at it typed there, it sounds impossibly irrational to me. To be honest, I'm ashamed of those fears. I feel guilty for not enjoying my pregnancy the way I was "supposed" to. After all, pregnancy after years of infertility should be cause for a grand celebration, right?

When I reflect on the five years of reproductive failure that preceded my pregnancy, though, the irrationality begins to make some sense to me. Cycle after cycle, year after year, our hope eroded away. When we did achieve pregnancy, miscarriage followed. I was conditioned to expect failure.

Pregnancy does not cure infertility. I still had to wrestle with feeling defective as a woman; I still had to reconcile those years of disappointment and heartbreak with the reality that a healthy, viable baby was growing within me. It was only when my OB laid my newborn child on my chest that I felt joy and hope again. (And, please know, I did feel and am still feeling a lot of joy now!)

I debated whether to share this post after I wrote it. But I'm certainly not the only person who's experienced these feelings during pregnancy, and it would have helped me to see stories like mine. I also hope that we, as physicians and healthcare providers, will allow our patients the space to experience their pregnancies authentically regardless of our personal feelings or society's expectations.*

I feel a complicated web of emotion around motherhood and how I got here. But I keep telling myself that here is a pretty fantastic place to be, all things considered. Our baby is a miracle and every day with her is a gift.

And that's more than enough for me right now.


* This hyperlink is to a post that contains explicit language. It is a raw and honest piece that includes f-bombs and frank anatomical references. If that won't offend you, please give it a read.