I am spending a year as the Trauma, Critical Care, General Surgery Research Fellow at Mayo. I have time to focus full-time on projects that will hopefully make a difference, expand knowledge, and really help our patients. I have aspirations of completing a couple of Quality Improvement projects, which is a very particular type of research with roots in sophisticated industries that have developed complex strategies for minimizing risk and errors. I have attempted a project before and essentially got nowhere, as I didn’t even know where to begin. So I signed up for the Quality Academy, which in true Mayo fashion, was an efficient, information packed, slick course that gave us all the tools we needed to get going on our projects. We covered a broad range of topics, and I was inspired by many of the thought processes and exercises presented there, but non stood out to me as more profound that the so-called “Change Despair Curve.” It looks something like this:
Now this was not the exact curve in our presentation, but it’s essentially the same. The curriculum stated that any change, whether personal or institutional, small or large, is accompanied by this same terrible transition by all involved parties. Even if the change is obviously positive and gets unanimous support at the beginning, there is a valley where everyone is bummed.
The reason I thought this was so profound is that I have seen it play out in my toddler’s reaction to 100% of suggestions I have made to her in the past 6 months or so. That’s not an exaggeration. I say, “Banana?” and she gives me a tortured expression and says, ‘NO DON”T WANNA NaNeeeI!!!” before her face softens and she holds out her hand for the gift. Every transition, change in our momentum, new idea, or suggestion of any change in the current activity and state of affairs is met with initial resistance. So of course I smugly thought, “Ah motherhood, giving me yet another edge in the professional world,” and gave myself a mental high-five.
This curve represents the challenges we will all face as we try to do good in the world by changing the status quo. All stakeholders will eventually get sore with us and with our ideas. We will get depressed about our projects and moving and traveling and starting new ventures. We will have to convince ourselves and colleagues that the change is worth it, over and over again. With perseverance, what is there on the other side of the difficulty is higher quality projects and a life of more purpose and impact.
I encourage every professional interested in global health to get acquainted with the principles of Quality Improvement, as we should be held accountable for proving the quality of any new endeavor or change we implement. We need to show that the change and resources required are justified, and having the right tools to do this analysis is part of the job description of a humanitarian physician. If your institution does not have resources available to get you started, email me at joy@indiedocs.org and I will send you everything I can to help.
What life-lessons have you learned from something like “Quality Improvement?” How important do you think quality research projects are to the field of global medicine? Please leave comments below!
June 30, I walked out of the OR around 8:30 p.m., finished my floor work, and turned off my pager, placing it into a pre-addressed manila envelope. I changed clothes and walked out of the hospital for the last time as a General Surgery Resident at the Mayo Clinic in Rochester, Minnesota. It is surreal to have this challenge behind me; 6 all-consuming years of my life including my Surgical Critical Care Fellowship, not to mention medical school and the preceding marathon of hard work and stress. I started this website near the end of my residency and had planned to do a post on our crazy dual-residency routine (my husband Josh is a neurosurgery resident), but with board prep and trying to wrap up a million tasks on the to-do list, I never got around to it. Still, I think sharing what life was like these past few years might help someone else navigate their own rocky trail, so I thought I would share some of the more pragmatic aspects of how Josh and I managed our day-to-day routine. In the spirit of Indie Docs, I would like to emphasize that no two lives or routines look the same, and this is all about cultivating our best life and thriving where we have intentionally and stubbornly planted ourselves.
First, we needed quite a bit of help and intentionality to make having a family work. I researched possible childcare options before deciding to start a family; I could not even mentally commit to becoming a mother without having a workable plan. I honestly didn’t think it could work until I researched the au pair programs. I was surprised to realize that the program was affordable, particularly in comparison with the larger full-time daycares (with extended hours) in my city. Having someone live with us was essential since we were often both on-call. I planned to return to work after 6 weeks, and the au pair couldn’t start until the baby was 3 months, so I reached out to family members to help me and was so blessed that my aunts were able to move in with us for 6 weeks to fill in the gap. Looking back, I wish I had considered just slowing down and staying home; I didn’t even seriously look at the finances and just assumed I needed to get back to residency. This was a very hard time physically and emotionally and not something I ever advocate for families and babies, but I digress.
Finally home from work.
The au pair program limits work hours to 45 per week, so we needed daycare in addition to the au pair. My husband had a stroke of genius in finding our daycare. He searched for all the childcare licenses closest to us, and just started cold-calling them based on proximity. Less than a mile away, in our neighborhood, was a wonderful lady with decades of experience and an opening! Once we hit that 3 month mark, we had our au pair and day care established. For the next couple of years, the routine was essentially the same; I left home around 5:30 or 6, our au pair would keep the baby until 8:30, drop off at daycare until 3:30, then keep baby until we got home around 6:30 or 7. My husband and I did our best to stagger our call nights, but there were plenty of nights when the au pair knew she was also “on call” and we would wake her if we both got summoned to the hospital.
Next for my working-nursing-mom spinning-plate trick: I was hoping to breastfeed as much as possible, but I honestly expected to need to do a combination of formula and breastmilk. I even had a package of formula on hand when we got home from the hospital, just in case. I was lucky enough to have a great supply, and I managed to keep a schedule that allowed me to pump enough milk to create a surplus before going back from maternity leave and then more than enough to keep up with day to day demands for the next year. I’ll be candid here, I was freakin’ proud of myself for making all that milk and for having the discipline and determination to keep going through the year. I’m happy to share my specific schedule with anyone interested, but in general terms it took a lot of time, energy, and so so many calories. I ate more at this time of life than I could even have imagined before. I pumped while getting numbers, while dictating, answering pages, patient phone calls, reading…I may have also nodded off a time or two at 3 a.m. in the ED pump room. I also dealt with a few unsupportive colleagues and staff. One OR assistant told me not to tell him when I was going to pump because it was gross, to which I replied, “Well, considering you are alive, I’m assuming YOU were also breastfed around 50 years ago, so that’s a tad hypocritical.” He laughed and was very protective of my pump-time afterward. On the other hand, one of my attendings never ever wanted to hear about it and wouldn’t even give me 5 minutes between cases (she wanted me there for turnover) to hand-pump in the restroom (I attempted this out of pure desperation because I was in engorgement agony), and I got two bouts of mastitis on her service. Despite the challenges, it was worth it to have the bonding time with my baby and feel like I was providing for her even while we were separated so much by my work schedule.
As a money-saver, (and probably also as me wanting to go the extra-mommy-mile as over-compensation for working so much, ahem) we use cloth diapers. I had help with the laundry from my au pair, but honestly the effort expended on this routine was minimal. I would much rather do a load of laundry than rush out to the store to grab a pack of diapers. We used disposables for travel and at night. After getting used to the routine and realizing how much money you can save even using cloth diapers some of the time, it’s hard to believe that cloth diapers aren’t a more common part of life for most families.
Whenever we had a weekend off together, we were intentional about trying to spend time outdoors. We got into camping during the beautiful Minnesota summers, and we hiked as much as possible.
Camping on the bank of the Root River
I used either a woven wrap or a Beco baby-carrier for hikes. We also have a big Osprey baby carrier gifted to us by a neighbor for serious backpacking, which we’ve only used a couple of times, including for a music festival (Eaux Claires).It was pretty awesome for keeping the baby strapped in and comfy while we carted her around from stage to stage.
Eaux Claires music festival 2017
Admittedly, we didn’t get much time to ourselves for the first 18 months or so, as we were constantly trying to maximize our family time during golden weekends. Having an itty-bitty is stressful for many healthy relationships, and we are no exception. For 10 years together before our first child, Josh and I thrived on spending lots of time with just the two of us, and suddenly we had almost none. One revolutionary change we’ve made in the last 6 months is having date-nights, which has been wonderful for our relationship.
The days and nights over the last couple of years have gone by in a blur. I could not possibly be prouder of my little girl or of my husband. She is thriving with her routine, and she is incredibly loving and affectionate with us, our animals, and her many baby-dolls. Josh is in the thick of his Chief service time now, but I have opted for a research fellowship with a flexible schedule this year in anticipation of baby #2 arriving in September. I know that I will always cherish having this short, precious time to spend with my girls while they are tiny, and it will help me feel eager and ready to take on my first position as a trauma surgeon after Josh graduates next year.
Moving forward as physicians with humanitarian-focused careers, we will need to remember how to focus our time and energy on what truly matters to us. I’ve discovered some amazing resources to help focus our priorities by Jillian at Montana Money Adventures. Mrs. Montana has created some wonderful mentoring worksheets for focusing time and resources that I will be utilizing and sharing here at Indie Docs. Many thanks to Jillian for sharing her wisdom and for being open to allowing us to document how we are utilizing her worksheets.
Until then, I hope that catching a glimpse into our world can help someone realize that having a happy family is possible even with our career demands. In fact, you can be an extended-breastfeeding, cloth-diapering, baby-wearing, semi-crunchy-granola mom AND a surgeon! The key for me has been accepting our reality and feeling satisfied in my efforts (no guilt) and cherishing the precious time I was able to spend with my baby. Also, asking for plenty of help, especially in the realm of childcare, was key. In turn, my hope looking ahead is for a happy future of global surgery work, travel, and a happy family. For me, that’s what Indie Docs is all about.
Enjoy this hilarious, heartbreaking, and candid tribute to nursing moms…
I have to admit that I really feel like I have it all. I complain about my crazy and exhausting life sometimes, but I wouldn’t change it. I have the residency of my dreams and I’ve reached the end of my Chief year (Holla!!!), the man of my dreams (you’ll appreciate this more in a minute), and a beautiful and fascinating baby girl. I even have a borderline-magical beast of a dog that will get his own post one day, but suffice it to stay he’s my hero and definitely one of my besties.
There is a detail in here that is actually quite vexing to me, and it’s the mom part. We were married for 10 years before having a baby, and during that time, I was pretty hard core anti-motherhood. I read and related to articles examining the decision to never have kids. I was “not maternal.” I couldn’t talk to kids. I was impatient. I didn’t like clutter or messes. I was 100% career driven and proud of it. So what happened? Well, I slowly started to get to the point where I didn’t want to choose between a career and a family. Certain aspects of motherhood started to appeal to me, and for half a dozen little reasons that aren’t important, I decided I wanted a baby. I figured out that an au pair would be essential and also doable with our money and space. So I became a mother, fully expecting a tsunami of life-altering invasions of time and privacy that would leave me grouchy and struggling to maintain sanity. That’s what all the advice focused on, right? How to “survive” the first year. How your life as you know it gets destroyed by a baby and you deal with it for 18 years.
Well that’s not how it happened. From day 1 to now day 600-and-something, it’s been fairly awesome. Truly, I’ve loved it. I’ve given up lots of sleep, yep, and breastfed forever, pumped countless time between cases, felt the push and pull of work responsibilities and fatigue, but I’ve never felt like it wasn’t manageable or that it destroyed my life. It’s been fine.
How is this possible? Well, firstly I would say that I have no shame about asking for help raising this little angel. Yes it would have been more enjoyable to stay home more, I fully admit, but that’s not the path I chose or was meant for, so I enlisted the help of my two aunts when Eddy was an itty bitty (6 weeks to 3 months) and then an au pair plus day care as she got a little bigger. She loves day care and our au pair, so even though her day from 6 a.m. to 7 p.m. routinely is with them, I don’t get stressed about that. Secondly, Josh and I have equal parenting responsibilities. I’ve observed that in many families, even where the woman works full-time, the mom is the “dominant parent,” responsible for much of the mental burden of planning and decision making among the family. Josh simply doesn’t have the reflex to push that stuff onto me, and for the most part I let him do things his way. Admittedly, Dad-style can be less polished (like when the baby’s clothes don’t match or fit and are out of season), but is reliably more efficient. I’ve actually adopted some of his techniques and been happier for it!
From the beginning, I have had a routine of bathing Eddy and safely co-sleeping (according to pediatric safe sleep guidelines), and so we spend all night together. This has helped me feel like I wasn’t missing her so much and I think it also strengthened our bond and made nursing much easier at night. I think another key has been that I learned a parenting style from my Mother-In-Law, who had a very late in life baby, that allowed for a full range and display of emotions from the little one without taking it personally or even reacting. I joined a gentle parenting group on facebook that reinforced these principles, and I think it saved my sanity and helped me maintain patience. I got into a discussion one time with a friend who was absolutely miserable trying to stay firm with their 1 year old over sleep training, and in that discussion I created a new mantra, which is “If snuggles solves the problem, there really is no problem.” I will fully admit, this philosophy is as much about my happiness as my child’s.
I’ve been thinking about parenting in the context of pursuing humanitarian work and the Indie Docs lifestyle quite a bit. Josh and I have talked about the best way to raise our kids and make sure their education doesn’t suffer. In the process the topic of being flexible has come up, as has different parenting cultures. Josh sent me this article the other day: Secrets Of A Maya Supermom: What Parenting Books Don’t Tell You, and it was a great article talking about how skewed our idea of parenting is in Western Society. I love the author’s imagery of how we have put parenting, motherhood, in particular, but this is relevant to the many stay-at-home Dads I know, in a box and expect one person to do it all. It’s not normal or necessary, and I think it generates a lot of anxiety and misery among parents. Of course, reading the article I felt validated in my parenting style (after being called “crunchy” a few times in various contexts) and in my skepticism of some parenting advice I was hearing over and over (like hard-core sleep training, we can have that discussion another day).
Perhaps more relevant to Indie Docs per se is the fact that we will demand a lot from our kids as we pursue this mission in life. They will need to understand that a huge portion of our time and money goes to help others. They will have to be flexible and adaptable to other cultures, and will likely sacrifice some aspects of the prototypical American kid existence from a social or sports context.
Now to inject some reality that life is not a fairy-tale. I got mastitis 3 times on a rotation where my attending would not let me pump. I was so tired one time that I came home and while holding Eddy to nurse her, I hallucinated that it was raining inside my kitchen. I’ve gone on a job interview just to have a night away in a hotel, and I felt FABULOUS after getting that night of undisturbed sleep. I’ve let the au pair feed Eddy her dinner while I hid in my room either power napping or vegging out for 20 minutes. Our marriage has undergone a tectonic-plate-shifting adjustment, and I had to delve into relationship podcasts and articles to try to undo some of the damage done by the paucity of quality time we had together. Going back to work when Eddy was 6 weeks old was one of the hardest things I’ve ever done in life, and her sleep habits only got worse over the next 6 months when she was waking up every 2 hours to nurse. But we coped and managed and continued to enjoy the moments and milestones along the way.
Fortunately, I did not experience postpartum depression, or have a colicky baby, or have any major medical concerns that would be much more challenging and beyond my control.
This is a huge topic that is both paramount to life as a physician parent and in related to upcoming big decisions about where and how to raise our kids. I hope to become more open minded in how I guide my little one through life, and most of all I hope I can maintain the inner peace that motherhood has brought to me. And to any reluctant trainees contemplating whether it’s worth it, I can offer my anecdote that having this child in my life is the most interesting, entertaining, and warm-fuzzy-feeling-inducing thing I’ve ever done. As The Ruth Bader Ginsburg has said, having a career and being a mother gives balance, and one helps you find respite from the other. I hope everybody finds their tricks and techniques that can make this huge responsibility wonderfully enjoyable.
Happy Mother’s Day to all moms out there making it work!
