thar's a snake in mah boots!

Undoubtedly the scariest call I've gotten from work happened this Thursday, when the director of the chess club that Cal attends after school called that afternoon to say that Cal never showed up, and did I know where he was?  (I was at work and of course freaked out because OMG MY BOY IS LOST.  Long story short, Cal just forgot it was chess club day and so missed the bus that was to take him there--we tracked him down ten minutes later patiently waiting in the principal's office for someone to pick him up.)  So yes, that was scary.  But the second scariest call from home I received the day after that, when our nanny told us that she came home from school pickup to see two large copperhead snakes sunning in our driveway.

Joe and I pulled in from work at the same time, and there were no snakes visible, sunning or otherwise. Joe went peering by the back door to see if the snakes were hiding under this storage unit we keep there for balls and frisbees and assorted outdoor detritus, and said, "I don't see anyth--" before jumping back in the air about three feet.  Because there was this:

I don't think I realized that I was scared of snakes until that day.  I knew I was scared of cockroaches--growing up in an apartment in New York made me more than familiar with that particular evolutionary success story--but I honestly can't say I've really seen a snake that big outside of a zoo, behind a guardrail and an information placard and a thick, reassuring layer of plexiglass.  But now, peering out from the inside of my house at the venomous snake chilling outside, I can confirm that yeah, for sure, I'm afraid of snakes.

I mean, LOOK AT IT.

LOOK AT THAT FUCKING SNAKE!

(Borderline related: did anyone who got the iPhone 5 on release day have any input as to its improvements when it comes to low-light photography?  As someone who lives in a low ceilinged ranch house with not enough windows, I am interested.  Please weigh in if you're in the mood!)

Anyway, I looked at it and screamed girlishly. Then we called the kids to look at it and they did not seem particularly perturbed (or indeed even that interested), though I gave them both a stern talk nonetheless about if you see a snake don't go near it, it doesn't want to hurt you but it could bite you if it gets scared (I left out the part about tissue necrosis and the potential need for serial debriedments and fasciotomies because WHATEVER, TMI).  They shrugged, glanced and the snake through the window again before going back to their Legos.  But I could not be so blase about it because the snake, OMG the SNAKE.

About half an hour later the snake slithered away under some shrubbery along the side of the house, at which point we could see that the tip of its tail was a little squashed from our nanny accidentally running over it with her car when she first pulled into the driveway.  We noted where the snake was headed as we had already called A Snake Guy (I believe his official title was "Wildlife Removal Specialist") to come by and check our property the next morning, and wanted to give him a little help in finding what might be the nest, or as I called it, Snake HQ.

I was on call this weekend, so when I walked to the car Saturday morning (down a poorly lit driveway that my mind inconveniently imagined to be PAVED WITH SNAKES) I did again see one snake lying there in the middle of the driveway, not moving.  I didn't know if it was the same snake as yesterday and frankly I didn't care--I hurriedly got into my car (which was probably teeming with SNAKES) reached into my bag (also stuffed full of SNAKES) and started the engine (ditto SNAKES).

The Wildlife Removal Specialist showed up later that morning while I was at the hospital, and though I wasn't there, Joe said that he got rid of that one driveway snake (it was the same snake from the day before, already dead, probably from the inadvertent tail squishing--and it was inadvertent, because even though none of us like snakes and even though the snake could bite our kids/dog/selves, I don't think any of us has the stomach or cojones to kill a snake), sprinkled some "granules" in the high-suspicion region by Snake HQ (purportedly a repellent of some sort) and put down two glue traps that looked for all the world like the ones I could buy at Home Depot.  Total bill: $230 for half an hour of work.  He did not find a nest or any other snakes in the area, though it's not clear to me how hard he looked--half an hour in an area as dense with ground cover as our yard doesn't seem like a whole lot of time to spend combing the premises.  And the glue traps were covered with leaves by that evening, so it's really uncertain how effective those are going to be.

(This is probably a good point to tell you guys that I'm quitting my job and becoming a Wildlife Removal Specialist.  They have a higher hourly rate than I do and they don't have to pay malpractice insurance.  All those years of medical training wasted, but whatever, sunk cost.)

So that's that.  But what bothers me now--what really bothers me--is this: our nanny said that she returned from school pickup to find two copperheads sunning on our driveway.  Two.  One of them got accidentally squished by her car, and that's the one that we found, and that the wildlife guy removed.  (YOU GUYS HE DIDN'T EVEN KILL THAT SNAKE HIMSELF.  $230?  Really?)  But the other one we never saw again.  So in all likelihood, we may still have a large and extremely poisonous snake still hanging around our property.  He could still be in our yard.  He could be hiding under my car.  He could be calling me on the phone and oh my god, get out, the call is coming from INSIDE THE HOUSE.

So basically we have to move now, right?

great and lesser expectations

I had Cal three weeks after starting my training in anesthesia--a highly conspicuous move that I think indelibly branded me for the rest of my academic career as "that pregnant resident"--so I think it's fair to say that I have some insight into the assumptions that people tend to make about people mixing family with a career in medicine.

In most ways I imagine it's not unlike mixing family with any intense or high-powered careers--look at all talk that Marissa Mayer's pregnancy incited after she was named the new CEO of Yahoo. (Aside: I'm not saying that my career is anywhere near as high-powered as that of Marissa Mayer, just that the case is emblematic). Particularly in the field of anesthesia, where I'm in the room but often lurking in the background or behind a drape, I've heard a lot of conversations about medicine, other physicians, and things that fall in the rubric of "lifestyle choices"--conversations that maybe weren't meant for me to hear.  But as a result, and as a result of living my own life, I can say for sure that women in medicine (physicians in particular) who choose to have children during the most active parts of their careers suffer under what I'd describe as a handicap of perception.

Perception. Not an actual handicap, but one of perception. There's a Chinese saying that my dad always uses that roughly translates to, "When you're walking through someone else's pumpkin patch, don't bend over to tie your shoes." (OK, that's a very rough translation--I don't think the parable from which the saying was taken originated during a time when shoelaces were a particularly popular feature of Chinese footwear.) What it means is: if you're in a setting that breeds suspicion, try hard not to do suspicious-looking things, no matter how innocent they actually may be. Because you may be just tying your shoes in the middle of that pumpkin field, but a casual observer might be inclined to think you're actually stealing those pumpkins.

I think that in medicine (and perhaps in the working world in general but what the hell do I know, I've never had a real job doing anything else) people are quick to assume things about working mothers, not too many of them flattering. I'd like to say "working parents" because believe me, I'd love for us to get to a point where there is actual gender parity on the issue (to be fair, I do think that Joe and I do have gender parity when it comes to parenting, but...we do have to leave our household occasionally and interface with the world) in the year 2012, this is still more of an issue of perception for working mothers. The following is a list of some of the things that some people are quick to assume about women with children who work outside of the home.


1.) We don't work as hard.

2.) We complain when we do have to work as hard as everyone else.

3.) We want special favors and allowances in the workplace because having kids somehow entitles us to them.

4.) We are unreliable because something's going to come up with our kids and we're either going to leave our co-workers with the extra work, or sometimes leave our jobs entirely.

5.) We just don't care as much about our jobs as our counterparts.

5.) All this is somehow inevitable.


The problem with other people's perception, especially those colored by preconceived notions, is that there's very little that you can do about it.  It has very little to do with you, and sometimes even very little to do with reality itself.  And that perception can be insidious, like a Chinese finger trap--the harder you struggle against it, the tighter it binds you.  (Yes, again with the Chinese.  WE HAVE A RICH CULTURAL HISTORY, OK?  Actually I have no idea whether Chinese finger traps are actually Chinese, or just "Chinese," like fortune cookies or General Tso's chicken, but whatever, it's not germane to the metaphor.) You want for all the world to defy the lowered professional expectations that people have of you, to prove them wrong, but sometimes it feels that the harder you try, the more you're reinforcing them nonetheless.

So what I think a lot of female physicians with kids do--and what I know I certainly do--is overcompensate. You do it all and then some. You work even harder. You try to never complain about your schedule or your hours while you're at work. Not only do you not ask for special favors, you embrace situations that allow you to prove that fact. In other words, you try to work as much and as hard as everyone else, and then you go a little bit farther, just to make sure. You try to be above reproach.

Sometimes this works. Sometimes it doesn't.

I think often now about Michelle Obama, particularly during the president's first presidential campaign, and how hard she and her team had to work to control her image.  The reasons people might have a negative impression of her are perhaps multifactorial and not entirely flattering of a portion of the electorate, but there seemed a point where every little thing she did or said, no matter how innocent, was misconstrued as playing right into her detractors' expectations.  (The endearing but now notorious fist-bump comes to mind.)  Sometimes it feels that way to me too.  Representing not only myself, but working mothers in medicine as a group, I am very aware of trying to present myself, present all of us, in the best possible light.  Again, overcompensating.  I think this explains a lot of my personality at work, which I have often classified as "aggressively pleasant."  As in: I will be easy-going and pleasant to work with if it kills me.

Sometimes this gets pretty tiring.

I also will note that there's a segment of people who will respond to this blog entry with the opinion that I and others like me are far too sensitive about these issues, reading meaning into things that have no meaning, turning mountains into molehills.  I am perfectly fine with people responding however they want (as someone who has been writing online for more than a decade, I think that if it's your right to publish something online it's the right of your readers to respond, even if they disagree with you) but I also think that actually being a working parent in medicine, a working mother in particular, lends you a perspective that you don't have access to otherwise.  So saying that we're overly sensitive to the issue of low expectation or perception bias is, to me, a little like a straight person saying to a gay person that they're being too sensitive about homophobia, or a white person saying to a Latino that they're too sensitive about racism.  Or, maybe, like Mitt Romney condescendingly telling poor people that they just don't work hard enough.  If you don't know what you're talking about, sometimes it's best not to talk.

I would love to hear your own stories about whether or not you feel that working parents in medicine are stymied by lowered expectations or perception bias, and what you all do in your lives to roll with the punches.  Because though the natural (or perhaps easiest) reaction is, "Screw 'em! Who cares what people think?" (this is Joe's response, for example) the fact of it is--I do care.  I care what people think of me in my career.  I care not only about being a good doctor, I care about being perceived as a good doctor.  I care not only about having a good work ethic, but about having that work ethic be a key part of how people see me. I care.  Maybe not as much as when I was in training (when I wouldn't even have dared to write a blog entry like this at all, for fear that I'd be seen as "whining") but I still care a lot.  So until I stop caring, or society changes as I continue to hope it will, I guess I'll keep walking through this field, head up, eyes straight ahead, and try not to look like I'm stealing pumpkins.

physician heal thyself *

Six hours into my second day back at work, while on call over Labor Day weekend, this happened.

I thought twice about posting this picture right up at the top, above the fold, but in the end, figured--you know this is a medical-ish blog, right?  It's just a little blood, right?  YOU CAN HANDLE IT.  (You can tell me if I should have thought three times about it instead.)

Anyway, I won't get into too many of the details of how the injury happened--mostly because in the past two weeks I've told this story at work about fifty skrizillion times and am bored of repeating myself--but let's just say that it was obtained while doing a procedure on the general medicine floor, and happened due to a combination of 1.) suboptimal conditions, 2.) poor equipment design, and 3.) poor judgement (my own) in persisting to use said equipment despite #2 in the setting of #1.  Be careful with your sharps, everyone.  They are...sharp.

Anyway, after finishing the procedure (I luckily had a second set of sterile gloves in my pocket that I was able to put on to finish off the task--a task on a patient that was not at a point where I could walk away) and though the glove was all flabby like a water balloon of blood by the end of the procedure, had a nice tight cuff that contained all my lifeblood quite nicely.  Then I irrigated my wound, finished the procedure note, and made haste down to the emergency room, where they took very good care of me.

I was instructed to get my stitches out in ten days, but the problem with wound care on your hand when you work in a hospital is twofold.  One, you have to keep your wound pretty covered up at all times--I basically had it laminated with a combination of Steri-strips, Tegaderms, and various configurations of bandages for the entire ten-day course the stitches were in.  Secondly, as I think I have mentioned before, I was my hands a lot during the course of an average work day, and no matter how occlusive I tried to make the dressing or how "waterproof" the various products used purported to be, my wound spent the better part of the ten days marinating in a brine of Band-aid water.  I tried to take the dressings off when I got home to let the laceration breathe, but the tails and knots of the stitches kept getting snagged on various things (clothing, towels, the kids' faces) so I ended up keeping the bandages on most of the time I was home too--another place where, between food prep and giving baths and changing dipaers--I had to wash my hands almost as often as I did at work.

So when my stitches came out this past Wednesday, the wound looked...rough.  First of all, it didn't really look like it had healed at all.  It was still gapping significantly, I could still see adipose through the edges of the wound, and the surrounding flesh and skin looked all ragged and macerated.  Joe offered to close it for me again, in layers this time with subcuticular stitches, but after mooshing it around and considering, I decided that I would just take off all my bandages whenever I wasn't in the hospital and let the whole thing dry out and close by secondary intention.  I was going to take a picture of the wound at this point, but be thankful I didn't, it looked even more gory on Wednesday than it did when I got the injury in the first place.  But anyway, it looks like Project Dessicate and Granulate is working, because now, three days after my stitches were removed, my hand looks much, much better than it did a few days ago.

(You'll just have to trust me on that last point.)

*          *          *

So, I'm back at work!  And it is...OK.  Actually, it's kind of hard to say how it's been and how it's going to be, since we haven't really officially pressure-tested the system yet.  Joe's mom, upon hearing how stressed we were about juggling everything, swooped into town the Tuesday after Labor Day and has been helping out with us at home for the past two weeks--getting dinner on the table, helping Cal with his homework when I'm working late, holding the baby so that Joe or I can go to the bathroom, entertaining-slash-distracting Mack, and any of about a billion different things that tip the balance of our mornings and evenings from smooth to totally unmanageable.  The kids have been delighted to have grandma in town, and it's made the transition overall much smoother.

Unfortunately, she has to go home tomorrow.  So after that, it's sink or swim.  Well, sink, swim or bob, I guess.

Overall, the difficulty with finding our new balance point now that I'm back at work is not so much getting everything done, but deciding if how we're choosing to allocate our time really is the best. Essentially a quality versus quantity argument. Well, let me revise that--it's not quality versus quantity so much as the concern that, with our current setup (three kids, Joe and I both working fairly extensive hours) that we may have neither. Part of the quantity element might be improved in a few months after my call schedule settles out--like I mentioned before, I have a pretty bad schedule for the rest of the year, I assume in part due to the leveling algorithm imposed by the computer system that my practice uses to assign our work assignments. And presumably, the quality of our time might improve when things settle down too--once the newness of the transition wears off, once the kids are more settled into their routines, once the baby gets a little older, etcetera etcetera. Maybe.

In the end, it's all doable, but we'll have to evaluate in another couple of months if the quality of the doing is really the best for everyone. Because I can't help but think--and this is judgement on no one but ourselves--that it feels awfully irresponsible to choose to have three kids and not choose to find some way to spend a little more time with them all.

* * *

You'll have to indulge me this last bit, but Cal's been just exploding with creativity since school started, and just recently, the stuff he's been writing is getting (in my utterly biased opinion) kind of good. He's been saying for a year or so now that he wants to be an author when he grows up, and while until now I've sort of considered it one of those classic Kid Aspirations (teacher, astronaut or similar--interesting to note, however, that Cal has absolutely no interest in becoming a doctor) this is the first time that I've thought there may actually be something to his plan. This (page one of his latest story) has a evocative "Hunger Games" or "Lord of the Rings"-esque feel to it, doesn't it?

(Cal hasn't watched "Lord of the Rings," by the way.  When I suggested that he might enjoy it, Joe shot me down saying that it was far too scary for a seven year-old.  I don't remember it being particularly terrifying, but what the hell do I know, I slept through the first two movies and didn't even watch the third.  What do you think?  Is it "Star Wars" level scary, or "Willow" level scary?  What is a scary kids movie, anyway?  Everyone talks about how magical "E.T." was, but that fucking thing terrified me as a child and still to this day.  That neck!  Those fingers!  THOSE WATERY TREMULOUS EYES.)

Anyhoo.  Everyone here's surviving.  Even doing well at times.  Hope you all are too.

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* I am fairly certain that I have used this title for another post before, but I've been keeping this blog for almost twelve years now so I'm fine with some creative reuse if you are.