Pregnancy in Medical School

"Remember people, well except medical students, typically reproduce before the age of 30."

MD, cardiologist

(via coffeemuggermd)

I’ve had this in my drafts for a while. It still pisses me off a bit. Not that it necessarily should, the cardiologist isn’t saying that no med students have kids before 30 but it’s atypical. 

What pisses me off, is that those who recognize that their life starts NOW, not after residency, or fellowship, or any other magical time, and want to have children are treated as wackos by most of our community. I know I rail on about medical culture and why it is not reflective of reality, but I’m going to do it again. This is another example of thinking that we need to change. 

There is research on just about everything that med students do. You’re the easiest population for medical researchers to bug, so they do.

However, I can’t find much research on being a parent in medical school.  This focuses on mothers (wall free article). It’s the only paper I could find (lots for residents by the way, probably because they are also leading a lot of the research). A lot of the young women I’ve spoken with felt they were treated poorly by the fellow students because they were getting “so many” allowances for time. The new dads in my class felt like they were expected to carry on as if there wasn’t a new sprog at home.  

Back to the paper, “Medical School-Mothers” in the Rhode Island Medical Journal. I’ve never heard of this paper, or this journal and I’m pretty damn excited about all things undergrad medical education and feminism. That’s disappointing. (Have you heard of it and I was just under a rock?)

They don’t tell us how many medical students were interviewed. I want to know what several means - is it 4? Is it 34? Help a sister in research out.

They also don’t discuss fathers. I get that women in medicine is new and all, but I want my colleagues to be good dads. I don’t want any of my colleagues to be fondly remembered by their grandchildren because their own children never saw them. 

“As part of universal precautions, all female medical students who are sexually active with men should be mindful of potential pregnancy.” BARF. Shouldn’t our male medical colleagues also be mindful? This reminds me of the episode in 2014 where a female medical student was at risk of losing her funding to study in Cuba because she “fell pregnant”, while her XY partner was not reprimanded. BARF I say. IUSs, condoms, and access to family doctors for all med students who want them!!

This article is mostly focused on what Student Affairs type people need to know (which is fantastic). 

But. 

What I would like to see is something that talks to many more students to provide curious students with help making decisions, something that gets more into the pros and cons of an educated choice. No one knows when the time is right to have children. Everyone has an opinion on it though. 

I’d also like to see a nation wide mentorship program - to be paired with an attending, hopefully in your chosen field, who also was a parent in med school. Knowing you have someone who has been there and survived. 

I’d like a handbook for parents in med school. Tips tricks and downfalls to avoid. I’d like this to be an open topic of discussion that starts in Year one. I want the parental leave policy to be pointed out to all students during orientation week. 

I want to know how much post partum depression and anxiety are present in the learners having children. We are all pretty crappy at taking care of our mental health, and how many of us have med studentitis? (Pregnant med studentitis is like that on freaking crack - everything that could possibly go wrong, will and you will blame yourself, even though you would tell your patients to think better of themselves. My friend had 10/10 stress through the last 4 months of her pregnancy. Uncool.) 

I want there to be scheduled check ins with Student Affairs during pregnancy and post partum to ensure this isn’t an issue. My suspicion is that the numbers of sufferers in the medical community are high. 

I want to get rid of the shame associated with wanting to be a good parent when you are ready to be one. Seriously. If we don’t stop acting like families in medicine are bizarre while we’re in first year medical school, how can we expect attendings to respect their colleagues and learners’ choices?

One of my colleagues is pregnant. I’m over the moon for her and her MD husband. The amount of stress they underwent preparing to tell the rest of the team about the (wanted, expected) pregnancy was overwhelming to ME. I’m not having a baby. Jeepers. They felt they needed to make it very clear that they do not want to stop practicing for more than 2 months each (like it’s not bad enough that they don’t get parental leave from our governing body). They were shamed into divulging the information much sooner than they wanted due to morning sickness. Our colleagues (all XY but me), have children with stay at home moms and incredibly twisted senses of what parenthood should look like with a physician parent. 

This has got to stop guys. We need to treat each other better and watch each others’ backs. 

What would you add to my list to make it happen?

Why cats are not doctors

Good to know.



But somewhat patient centred right?




This is unfortunately not species specific.

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Good dictation words

I use the word nefarious as often as possible in dictations.



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More Art and Medicine

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My new definition of gross

Parents who kiss their freshly born baby after they've marinated in meconium full amniotic fluid.
Yes we wipe the kids off first, but still....Ew.




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Unmet Objectives

Yesterday was my last day in the emergency department. It was a day of mixed feelings.

I didn't feel at home in this ED. They weren't familiar with having learners in the department and tended to make me feel uncomfortable and sometimes unwelcome.

The few preceptors who were enthusiastic to teach were a lot of fun to work with and I appreciated their caring and the cake they provided to say good bye with.

Despite my personal enthusiasm to learn, I only met a few of my many learning objectives. Part of this was from the volume we saw in the ED - I can't practice inserting central lines when there is no need for it. The preceptors were not comfortable with me taking the lead in cases where I could use my ACLS. It may be that they didn't realise that I was certified to help a patient whose heart had stopped.

I did however get very good at diagnosing UTIs, sinus headaches and sciatica as well as suturing almost any body part you can think of.

While I don't want to add an extra year of learning to my residency, I do want to be proficient enough to feel comfortable being the only doc in a small ED. I may need to either add learning through simulations or electives.

I really hope that my Internal Medicine rotation that I start next will be more fruitful.

She may be onto something

I'm at a medical education retreat. Our presenter on assessment has just said "our students can't give LPs to all their patients presenting with headache - it's dangerous".

I can't help but wonder though, maybe that would encourage PTs to try Tylenol or advil before coming into the ED.


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Waiting for our patient to be called into the OR

Until then, relax, watch Stuart Little and pretend I can't hear the nurses sniping behind my back. They clearly hate working on Sundays. That's too bad for them.



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What's the radiologist's favourite breakfast food?

The waffle.

I had three patients I was seeing in a row. One had a hurt forearm, one a sore elbow and the third (a child) had a sore ankle.

After listening to their stories I sent all three for x-rays.

When the x-rays came back, I thought, in order, fractured, not fractured and I don't know. I made my call to the preceptor I was working with who agreed on all counts. We treated the first and third patient as though they had fractures and the second as though it was a soft tissue injury (rest, ice, elevation).

Yesterday my preceptor for that shift showed me the radiologist's report. Basically he said that it could possibly be a fracture along the growth plate or a variance on normal. We should make our decision clinically.

Thanks for that illuminating report.


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My preceptor drank my pop!

I was so thirsty after class this afternoon but didn't have time to get a drink before the ER so I grabbed a pop from the vending machines. He drank half my pop before putting it back in front of me and going back to drinking his own.

If I'm not willing to tell a doc that he is putting his gross germs on my pop, how will I deal with a situation like the drunk surgeon we keep hearing about in ethical discussions.


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Only half an hour away from the hospital is this

Half an hour away from people talking about unconscious patients as if they aren't right there is this :



Half an hour away from specialists who act as though I'm the biggest idiot they've ever met is this;



It's good to remember that there is a life outside the hospital where I can hike and enjoy fresh air and running water.

Sigh.

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Another Post about 9-11

I don't have cable. It's not a moral superiority thing, I just know two things about myself. 1. I have a student budget and can't justify that expenditure every month and 2. I turn into a couch potato when I have an endless choice of programs to watch. Better for the world in general if I don't have it.

The morning the planes hit the towers in NY city, I was at my local bakery, in my PJs, as usual. Bleary eyed, I just wanted coffee. One of my customers from the restaurant looked distraught and said "it's so hard to believe isn't it?", I just numbly nodded. She was right, Tuesday mornings are ridiculously hard to believe.

When I got home and was working on my child development assignment, my friend called to tell me about the attack in NY. She knew I was clueless and needed to be told these things. I'm glad she did so I didn't continue to look like a fool the rest of the day when customers told me about the events.

I worked the lunch shift that day. It was not that busy. I guess people were crowded around the TVs at work watching and ordering in pizza.

At about 1:30, a volunteer from some charity came in looking for donations. She asked for a glass of water. Something seemed wrong. I asked if she was ok and she started to cry. Instinctively we hugged until she was OK to sit down. She told me her brother works in the Trade Centre in NY and she had no idea if he was safe or not. Terrifying. I got her the glass of water, held her hand for a moment or two, murmured the usual "don't paint pictures before you know the truth", and "remember he can't call out right now, he may be safe", then let her be. She was calmer when she left a short while later.

This was one of those "I should be a doctor moments".

The restaurant I was working in was run by a Chilean woman. She was a strong independent refugee from the other September 11. The stories she told me about Pinochet were terrifying. She was identified as a radical because she taught her neighbours how to grow vegetables, eat nutritious food on a shoe string budget and how to cook tasty dinners. She had a house full of children and a husband who lived elsewhere so soldiers assumed she had a gun in the house and abused her in front of her children. I don't see the logic in that, but maybe I'm not crazy enough. With her family and neighbours, she sat in the national soccer stadium and watched as those she loved were murdered in front of her then carried out to a mass grave.

I learned about PTSD and survivor guilt from this woman. She didn't realise she was teaching me these lessons because she didn't know and wouldn't acknowledge, that she was suffering.

When Pinochet died of a heart attack at 91, I was reminded that only the good die young. He had dementia in his last years, didn't stand trial for his crimes. I wonder if he ever knew the damage he caused so many Chileans.

Torchwood

I've been watching this new season of Torchwood. It's amazing. There are so many medical ethical issues that are being raised.

In a nut shell, people live forever so there are not enough resources to keep everyone in hospital. The sick are sent to what are essentially concentration camps. They are treated like things rather than human beings. It is a bit reminiscent of how we treat demented patients. They don't have rights and are spoken over rather than to.

Doctors' responsibilities are focused on dealing with placement of these "dead but not dead" patients.

I spent a large part of today's weekend rounds on politics. Moving patients between areas of the hospital, planning resources for patients to go to when they leave and continue to manage the health of patients who will never leave hospital. We sometimes find ourselves discussing the futility of certain treatments, choosing the course of treatment that is most cost effective. While we always consider what is best for the patient and act accordingly, it often feels that our conversations are centered on economics and politics rather than medicine.

According to the CanMeds roles, resource allocation is an important part of being a doc but it truly is my least favorite part.

I found myself today longing to just figure out a medical problem and make my patients healthier.


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"Things will get easier, people's minds will change, and you should be alive to see it"

I know it's cliche, but our media is not doing teenagers any favours.

Ellen's talk about the teen suicides in the US that are following bullying is powerful and long overdue. Not just by her, but by adults and media in general. Everywhere they look, media is focused on teens and telling them what to do, how to look and who they are expected to be. Bullying isn't just taking place by other kids targeting children kids who are different, who may or may not be gay.

Idiots on the net are suggesting that the kids who are killing themselves to escape the bullies were mentally unstable before the bullying began, that being gay is a form of mental illness. They clearly forget how hard it is to be a teenager. It's incredibly difficult to keep your wits about you while figuring out who you are and dealing with surges of hormones. There are few teens who are mentally stable to begin with. Add bullying to the mix and it's surprising there are more episodes of suicide than there already are.

I was one of those kids who was teased about being gay before I had discovered for myself that I wasn't. To me though, this teasing meant nothing because I didn't see anything wrong with being gay, as long as they didn't call me fat or stinky I was OK.

Again, movies, TV and magazines tell us that if we do things perfectly -by wearing the right makeup, dressing in tight clothes, sleeping with whoever we please, drinking alcohol and still being brilliant at school, friendly, athletic and thin - we will have more friends than we know what to do with.

No pressure.

Hard to imagine why kids struggling to define themselves are struggling so much. Each teen is fighting this battle and has a difficult time recognizing that they have peers fighting similar battles. It results in them feeling isolated and ignored and trying to find a way to be seen. They become bulimic, goth or emo; buy crates of makeup and perfume; dress like sluts; slowly self destruct.

I've spent a few weeks with the child psychiatry team and these messages and how teens deal with them have been at the forefront of my mind. There isn't a fast solution to the problem which seems to be systemic. All I can hope for is a change in the content of the messages being broadcast to our youth.

Imagine you're a ten year old kid. Your thinking is still very concrete; sarcasm and shades of grey are completely lost on you. If someone tells you that you are too chubby you believe it. If someone tells you there's an obesity epidemic - that being fat is unhealthy - you believe that too. Then you start to pay attention to other messages from media, school, peers and adults. Foods low in calories, low in fat and sodium are healthier choices. Empty calories that you get from foods like the pop and chips you enjoy occasionally with your family are not good. Rules for eating and exercising begin to be formed in your head, all because you want to be more healthy.

Congratulations, you now have an eating disorder. Not because you think that you are too fat and need to look better, but that you are unhealthy and want to become healthier. Without countering the restrictive messages with messages of balance, enjoyment and the importance of certain nutrients like fat, this ten year old can become an eleven year old who is so malnourished, has a heart that is so wasted of muscle its SA node no longer function and an EKG tracing shows a junctional rhythm. The only option is to put this child into the hospital, provide him with nutrients at a rate that will not cause refeeding syndrome, and teach him the way to feed himself in the future - a balanced approach to be healthy.

Adults and especially health care professionals have a responsibility to keep the messages kids receive safe. Ellen is right. This is a crisis.

more strange attitudes

I recognise that many people in the hospitals have seen things that are horrific, have been burned by patients and are genuinely jaded by their work.

It's still disturbing when nurses and docs are judgemental of patients who say they are trying to kick their iv drug habits; are pessimistic about patients who are HIV positive.

These patients are peoples' fathers, daughters. They are loved. To treat our HIV and IVDU patients as less than deserving of care does a disservice to the patients themselves and the people who love them.

Clerkship is over, let the slacking begin

I've been watching a lot of Grey's Anatomy. Realizing I am exactly like Izzy. Overly invested, bake to deal with stress, but much shorter and much less cute. Cute isn't everything. Figured I would do the quiz for kicks to find out

Awesome photo from Cute Overload, nothing to do with what I want to talk about today.

Despite the fact that Canada has "universal health care", not all our patients have access to this care. Women find themselves in a position of needing to choose between affording birth control and paying rent. I met one of these women who ended up pregnant, keeping the child and now has even more financial problems than if she had forgone her rent and bought birth control.

The Mirena IUD, one of the best options for women who are myopic in their health care choices, is the most expensive option at the initial outlay. It costs approximately $400. This is a one time cost and the Mirena lasts for 5 years. There is no need to remember to take pills daily or ensure his love is gloved to prevent a pregnancy. It's also a fabulous way to control heavy periods. The $400 is quite a bit for the woman who can't afford utilities.

Some docs are good enough to keep some of the samples given out by drug reps. This is disturbing on a whole different level. There is something to be said for beggars can't be choosers. If the birth control that may be the best choice for the patient (e.g. a mini pill, the nuva ring, mirena), is not available as a sample, then the patient gets the second (or third, or fourth) best option. Samples are given to the docs as good will from the drug reps to get their foot in the door, but also so that the docs can give them out to the patients who need them and see how they react and learn how the drug works.

New research out of Kingston shows that poverty plays a role in cancer prognosis. I assumed it would be because these folks are less likely to seek medical attention early, but one of the things they found was that patients presented at the same stage in their cancer. While it's true that we have universal health care in this country, we don't have universal access to healthy foods, education about our health and access to health promoting activities. The researchers are looking at "other factors such as tumour biology, presence of other illnesses, access to treatment, quality of care, or differences in nutrition, exercise and smoking may also play a role in survival".

the best part of working in the ED is days off

This morning I'm sitting on my patio with my cats, drinking Starbucks, eating a scone, loving my garden, enjoying the weather and Reading a book for fun.

FOR FUN!!!

I'm reading Complications, A Surgeon's Notes on an Imperfect Science by Atul Gawande. He's a general surgeon out of Boston and unlike the general surgeons I've recently experienced is very thoughtful.

The chapter I'm currently reading is about the need for learners to practice and the ethical implications that what we need to practice on are people. Given the choice between a fellow and a consultant caring for his son, even though Gawande himself was a resident at the time, he chose the consultant.

I know I keep coming back to this problem in medicine, but I really think it's an important one. Learners learn through practice but who wants someone to practice on the one they love?

How will we get to do enough procedures master them and allow the generation before us to retire?

Random facts about The Impostor - Med School edition

1. I often bath rather than shower before an exam. This is so I can study in the tub.

2. Even though almost everyone in my class thinks I'm intelligent, I'm barely making it through my exams.

3. Anatomy lab makes me HUNGRY. Which really grosses me out.

4. I'm addicted to having textbooks but rarely use them (though the Case Files series may convert me).

5. When my class chatters while we should be listening to a lecture, I'm ashamed of them.

6. I have consistently done poorer than the class average on all my exams and assignments but one.

7. I crave the approval of those around me. I worry what will happy when I move into my own practice and need to encourage myself - this is when the impostor part of me takes over.

8. I'm terrible at completing projects - I can have several going at once and never truly finish one of them.

9. Even though I know my school has a pass/fail system and that my potential residency programs won't see those marks, I worry that they will somehow find out that my marks aren't brilliant.

10. Drinking herbal tea with fun sounding names makes it easier to study for exams.

11. I watch TV while I'm studying. That likely explains my poor marks.

12. Every now and then I get these moments when I realise that I'm going to be a doctor - soonish. At first I go into this sense of awe and happiness, that is later replaced by abject terror. While I feel I can talk the talk, I'm not sure I'll be able to walk the walk. Maybe dermatology is the thing for me? I like raspberries in my water.

13. I want to specialize in everything.

14. Our class is incredibly charitable. We spend a great deal of time raising money for people overseas, kids who are chronically ill and friends who are fighting great battles. It makes me very proud of them.

15. My favourite block so far has been MSK. I like diseases and body systems that I can see.

16. I was drinking 8 cups of coffee a day. I'm down to 2 now because the hypertension and tachycardia caught up with me.

Maya Inspiration

It's so easy to be caught up in the every day, noting how difficult our lives are. Or maybe that's just me. I know that I need to give my head a shake and notice how much is going on for me when so many have such a difficult time. I was reminded this morning when I saw this clip. I haven't heard Maya Angelou read "I Rise" for quite a while and it was long over due.



In the same vein, the words to Phenomenal Woman also by Maya Angelou. It's who we are not what we look like.

Pretty women wonder where my secret lies.
I'm not cute or built to suit a fashion model's size
But when I start to tell them,
They think I'm telling lies.
I say,
It's in the reach of my arms
The span of my hips,
The stride of my step,
The curl of my lips.
I'm a woman
Phenomenally.
Phenomenal woman,
That's me.

I walk into a room
Just as cool as you please,
And to a man,
The fellows stand or
Fall down on their knees.
Then they swarm around me,
A hive of honey bees.
I say,
It's the fire in my eyes,
And the flash of my teeth,
The swing in my waist,
And the joy in my feet.
I'm a woman
Phenomenally.
Phenomenal woman,
That's me.

Men themselves have wondered
What they see in me.
They try so much
But they can't touch
My inner mystery.
When I try to show them
They say they still can't see.
I say,
It's in the arch of my back,
The sun of my smile,
The ride of my breasts,
The grace of my style.
I'm a woman

Phenomenally.
Phenomenal woman,
That's me.

Now you understand
Just why my head's not bowed.
I don't shout or jump about
Or have to talk real loud.
When you see me passing
It ought to make you proud.
I say,
It's in the click of my heels,
The bend of my hair,
the palm of my hand,
The need of my care,
'Cause I'm a woman
Phenomenally.
Phenomenal woman,
That's me.