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OWC Women Faculty Forum

A forum for all MGH women faculty to share personal experiences as a woman in academic medicine including:

  • how to balance your career and personal life
  • balancing a clinical or research career with family care (raising children or caring for elderly parents)
  • share your experience balancing other parts of your personal life with your career
  • your thoughts and perspective on being a woman physician/scientist in an academic hospital.

As the forum grows, we look forward to adding an interactive feature to allow discussions about the various topics that we cover. There is room for all of your experiences here, and we encourage you to contact the office if you would like to be considered as a guest contributor to the forum.

There are endless valid perspectives,wonderful stories,and nuggets of advice among the members of the MGH OWC community; we hope to hear from more of you who would like contribute to this forum.

 

June 2014
Jack Of All Trades, Master Of None
by Monique Tello, MD, MPH, Instructor in Medicine

May 2014
Managing Parenthood and Your Research Career
by Ann Skoczenski, PhD, Program Manager, Center for Faculty Development

April 2014
Why I’m Up this Late on a School Night
by Monique Tello, MD, MPH, Instructor in Medicine

March 2014
MGH Faculty Parents Group: What to do When Your Kids Push Your Buttons
by Ann Skoczenski, PhD, Program Manager, Center for Faculty Development

February 2014
MGH Faculty Parents Group: The Development of Empathy in Children
by Ann Skoczenski, PhD, Program Manager, Center for Faculty Development

January 2014
Making Electronic Devices Work for Your Family
by Ann Skoczenski, PhD, Program Manager, Center for Faculty Development

November 2013
MGH Doctor-Mom: Managing Call
by Monique Tello, MD, MPH, Instructor in Medicine

October 2013
Making it Better: A Faculty Mom's Ongoing Pursuit of Balance
by Shana L. Birnbaum, MD, Instructor in Medicine

September 2013
MGH Doctor-Mom: Managing Child-Related Sleep Deprivation, Part 2
by Monique Tello, MD, MPH, Instructor in Medicine

August 2013
MGH Doctor-Mom: Managing Child-Related Sleep Deprivation, Part 1
by Monique Tello, MD, MPH, Instructor in Medicine

July 2013
Welcome to the MGH Dr. Moms Forum!
by Monique Tello, MD, Instructor in Medicine

 


June 2014

Jack Of All Trades, Master Of None
by Monique Tello, MD, MPH, Instructor in Medicine


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May 2014


Managing Parenthood and Your Research Career
by Ann Skoczenski, PhD, Program Manager, Center for Faculty Development

If you are a faculty member hoping to start a family soon, do you wonder how you will balance parenting responsibilities with your demanding career in academic medicine? If you already are a parent, have you wondered about ways to better manage your personal and professional life? The Managing Parenthood and Your Career Series is one way that the Center for Faculty Development helps faculty and trainees find ways to meet the challenges of balancing personal and professional responsibilities.

On April 11, 2014 the Office for Women’s Careers and the Office for Research Career Development co-sponsored a panel discussion in this series called, “Managing Parenthood and Your Research Career.” The panel was made up of four successful MGH research faculty: Beth Costine, PhD, Instructor in Neurosurgery; Sara Lazar, PhD, Assistant Professor in Psychiatry; Eve Valera, PhD, Assistant Professor in Psychiatry; and Elaine Yu, Assistant Professor in Medicine. Our panelists have children ranging in age from infants to teens, and a wide variety of personal experiences including single and married parents, the career stage at which they became parents, and those with extended family living near and far. All of these factors contributed to a rich discussion between the panelists and audience members. Here are some highlights from the discussion, which was guided by questions posed by the Office for Women’s Careers and members of the audience.

How do you manage during times of intensive experiments and grant writing? All of the panelists agreed that the key to succeeding with critical work deadlines is to cultivate and use a “village” of child care helpers. Two panelists are single mothers, and they rely on a combination of family, friends and dedicated child care workers to help through intense work periods. The two with spouses emphasized the need to communicate often and early with each other and plan so that each spouse’s intense work time and free time complement their partner’s work needs. Most also relaxed their screen-time rules during intense work times.
What is the most useful professional activity to do during pregnancy to prepare for maternity leave? The panelists discussed how they attempted to complete time-intensive experiments that were critical to grant applications or publications during their pregnancies. They were mostly successful at this and they agreed that, if possible, one should try to submit a grant or major publication near the end of a pregnancy, so that the review process occurs during their maternity leave. While panelists had some success getting work done during maternity leaves, they all emphasized that one should not count on meeting any deadlines during this period.
What has been the biggest challenge at work since becoming a parent? The main theme discussed in answer to this question was the drastic change in the amount of time available for relaxed, informal conversations and networking after becoming a parent. The panelists were all acutely aware of fitting more work into less time spent at the lab, and trading daycare deadlines for chatting with colleagues. For some, social networking has filled this gap: from home during off-hours one can communicate with both local and long-distance colleagues through listserves, blogs and networking sites that are increasingly being used by scientists.

We appreciate the time that our panelists took out of their busy lives to share their experiences with the audience, and look forward to another vibrant Managing Parenthood and Your Career series in the 2014-15 academic year. If you are interested in suggesting a topic for the series or being a panelist, please email womens.careers@partners.org.

Additional information and resources:

“Improving Your Work-Life Balance” from ScienceCareers and the 2014 AAAS annual meeting:
http://sciencecareers.sciencemag.org/career_magazine/previous_issues/articles/2014_02_17/caredit.a1400045

Social networking for science careers: http://sciencecareers.sciencemag.org/career_magazine/previous_issues/articles/2014_02_28/science.opms.r1400141

http://www.ascb.org/ascbpost/index.php/ascbpost-home/item/113-using-social-media-for-scientists-who-swear-they-never-would

http://labroots.com/

https://twitter.com/MySciCareer


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April 2014

Why I’m Up This Late On A School Night
by Monique Tello, MD, MPH, Instructor in Medicine


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March 2014

MGH Faculty Parents Group: What to do When Your Kids Push Your Buttons
by Ann Skoczenski, PhD, Program Manager, Center for Faculty Development

“How do your kids push your buttons?” At a recent meeting of the Faculty Parents Group, this question was asked and everyone had at least one example to share. Here are just a few:

     A. When my son calls his sister “stupid.”

     B. When my child suddenly thinks of 13 things she needs to tell me, just
          when she should be putting on her coat to walk out the door (and we’re
          already late!).

     C. When my child refuses to put effort into music practice.

The main theme of all these experiences is that our kids say or do something that makes us go into auto-pilot and become emotionally reactive. Furthermore, when our kids push our buttons, we tend to make assumptions about what this behavior means for their future, their character, and our own parenting. We invited parent coach Danya Handelsman to speak with the Faculty Parents Group and help us understand what is happening in these situations, and how to diffuse our reactions and change our perceptions.

Two main themes came out of this discussion: first, the need to understand our own agenda and how that might differ from our child’s agenda; second the need to more fully understand our assumptions, and strategies for changing those assumptions.

Agendas. If you think about a time when your child pushed your buttons, and think about what your agenda is/was at the time, it often becomes clear that your child is following a very different agenda from you. Each individual’s agenda includes everything on our mind, whatever is demanding our attention, and our own expectations and standards. These agenda components may be very different for parent and child, and additionally, children’s temperament and stage of development factors into their agenda. In example B above, the parent’s agenda may be getting to work/school on time, while the child’s agenda is needing additional time and connection with the parent in the morning. In that example, the two agendas might both be met by getting up a bit earlier so there is more time for conversation in the morning. Ms. Handlesman recommends that parents remind themselves that, “my child’s agenda is just as important to him as mine is to me.”

Assumptions. Ms. Handelsman pointed out that often our assumptions about button-pushing situations cause us to have an overly harsh reaction, and moreover they are usually based on fears, not reality. Some typical assumptions when our buttons are being pushed are: my child is manipulating me, my child might grow up to be a criminal/sociopath, my child is lazy. As a way of helping us think about assumptions, Ms. Handelsman suggested that we try to think about the roots of our kids’ behavior, and in difficult situations remember that “the child is having a problem, not being a problem. One strategy to help re-frame negative assumptions is to keep a journal where you write down positive things about your child and positive things about you as a parent.

Members of the Faculty Parents Group found this seminar extremely useful, especially the “real-life examples from other parents,” the “concrete strategy and researched framework,” and “thinking about assumptions and reframing.”

For additional information on this topic, see these suggested readings:

Book: When Your Kids Push Your Buttons, by Bonnie Harris http://www.amazon.com/When-Your-Kids-Push-Buttons/dp/0446692859

Book: Playful Parenting, by Lawrence Cohen
http://www.amazon.com/Playful-Parenting-Lawrence-J-Cohen/dp/0345442865


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February 2014

MGH Faculty Parents Group: The Development of Empathy in Children
by Ann Skoczenski, PhD, Program Manager, Center for Faculty Development

On January 30, 2014, the Office for Women’s Careers, hosted a Faculty Parents Group talk on “The Development of Empathy in Children.” The guest speaker was Helen Riess, M.D., Associate Clinical Professor of Psychiatry at Harvard Medical School and Director of the Empathy and Relational Science Program in the Department of Psychiatry at MGH. Her research team conducts translational research utilizing the neuroscience of emotions, and they have developed an empathy training curricula that is implemented internationally in healthcare, as well as in business, and education.

Dr. Riess discussed the stages of empathy development from infancy into adolescence, and gave tips on how to model and encourage empathy in children:

    - Infants and toddlers begin to learn about empathy from the way that we treat them when they are upset, cranky or in distress. Consoling them, talking softly, and relieving their distress are all ways to model empathy. At this stage, understanding their need for security and validating it with physical touch is key.

    - Toddlers and pre-schoolers (as well as older children) are very sensitive to the physical signs that you are listening. Dr. Riess used a brief exercise in which participants paired up and briefly discussed an emotional situation, to demonstrate how our posture and gaze change when we are actively listening to someone. For children to learn empathic listening, Dr. Riess suggested that we remember to get on their physical level (e.g. by kneeling down), lean in toward them and mirror their posture and gestures. While these are all things that most parents in attendance were aware of, all agreed that when we are dashing to get home, get dinner on the table and get evening routines underway, we often rush past our children’s need for empathic listening.

    - The elementary school years are the time to add discussions about feelings to your interactions with your child. Help them to label their own and other’s feelings, create opportunities to talk about hypothetical situations where someone might be upset, and help your child to understand their feelings. Middle childhood, roughly ages 8-10 years, is the stage where children really begin to appreciate that other people may have different feelings in response to the same situation.

    - Adolescence often is accompanied by an apparent decline in empathy, as teenagers become very self-centered and concerned with posturing and developing a unique identity. This decline is temporary and is most evident in boys aged 13-15 years, and the most likely cause is an increase in testosterone during these years. This is also the age when boys may be feeling intense pressure to societal norms of “manliness,” and may act aloof to avoid being overwhelmed by their own feelings. Dr. Riess suggested continuing discussions at home that encourage perspective-taking, as well as being very firm with family rules about respecting other people’s feelings.

Additional information on this topic can be found in the following resources:

Helen Riess’ TedX talk on “The Power of Empathy”
http://www.youtube.com/watch?v=baHrcC8B4WM

Tips for helping your child develop empathy
http://www.zerotothree.org/child-development/social-emotional-development/take-a-walk-in-my-shoes.html

"From Mine to Ours: Nurturing Empathy in Children"
http://www.huffingtonpost.com/david-sack-md/empathy_b_1658984.html

Decrease in empathy during adolescence http://online.wsj.com/news/articles/SB10001424052702304561004579137514122387446


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January 2014

Making Electronic Devices Work for Your Family
by Ann Skoczenski, PhD, Program Manager, Center for Faculty Development

iPads. Smart phones. Nintendo 3DS. Tablets. The ubiquity of electronic devices means that all families are trying to navigate rules and expectations for their use. Yes, there can be a lot of educational value in these devices, but there is also a lot of addictive power in their use, not to mention constantly evolving ways to use them for social interactions and sadly, bullying.

The MGH Faculty Parents Group recently had two sessions to address these topics. In the first, David Bickham, PhD, of the Center on Media and Child Health, Children’s Hospital Boston, discussed “Media and Our Children.” This talk focused on helping children develop healthy tv viewing habits, and internet safety (see resources below).

In a follow up session, two of our parents, Ann Skoczenski, PhD, program manager in the Office for Women’s Careers and Helen Delichatsios, MD, a primary care physician here at MGH facilitated a discussion on, “Making electronic devices work for your family.” The facilitators and the attendees (parents of children with a wide range of ages, from infants to teenagers) shared what has worked for them, and commiserated on the complexity of allowing our kids to use these devices.

Here is a brief summary of advice and issues that were discussed for different age groups.

Toddlers – early elementary: For this age, the biggest challenge seems to be how to set screen limits, and most parents of young children questioned the ideal amount of time that kids should be allowed to access electronic devices. The general consensus was that most parents use their phones and tablets for short periods as a ‘babysitter’ (e.g. while cooking dinner, standing in a long line, taking a call from a patient), and most were comfortable with this in moderation. But there was agreement that we need to focus our youngest children on real-life social interactions, and everyone noted the need to avoid using our devices ourselves during family time.

Later elementary: This age sees a great increase in the amount of time that children (especially boys) spend playing video games. In middle childhood, access to video games seems to play a huge role in peer interactions. This is a time to pay close attention to the content of the games. Some are fun, others are just silly, but some are downright violent and misogynistic. Another hallmark of this age is that children are spending more independent time with devices, so we need to teach them internet safety rules, and set clear limits on their use (beware of “in-app purchases!”).

Middle school and older: Most children of parents in the group got their first cell phone at the beginning of middle school, and this is where things get really tricky in terms of monitoring kids’ use and protecting them (from themselves as well as others). The number of apps that kids use to connect with each other and post photos is constantly growing and changing. A whole book could be devoted to this, but the main points that were discussed were: the need to have an ongoing discussion about protecting your online reputation and the permanence of internet posts; and the need for parents to devote time to staying on top of their children’s smartphone and online activity to watch out for bullying and inappropriate behavior.

Please see resources listed below for information and advice. We encourage you to share your own ideas on this topic by emailing womens.careers@partners.org. We may compile your ideas and comments for a future posting or invite you to write for the forum.

Resources:

Center on Media and Child Health, Children’s Hospital Boston http://www.cmch.tv/

Setting screen limits
http://www.commonsensemedia.org/advice-for-parents/dont-touch-dial-tips-limiting-screen-time

Reviews of movies, apps and games
http://www.commonsensemedia.org/reviews

Internet safety and cyberbullying
http://www.fbi.gov/stats-services/publications/parent-guide
http://www.cnn.com/2013/02/27/health/cyberbullying-online-bully-victims
http://nyti.ms/163Jpfc

Kids and cell phones
https://www.lookout.com/resources/reports/smartphone-family-guide

Why your Snapchat isn’t so secret
http://www.sfgate.com/technology/businessinsider/article/ALERT-Your-Secret-Snapchat-Relationships-4814597.php

Bringing Up Geeks: How to Protect Your Kid's Childhood in a Grow-Up-Too-Fast World
http://www.amazon.com/Bringing-Up-Geeks-Childhood-Grow-Up-Too-Fast/dp/0425221563


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November 2013

MGH Doctor-Mom: Managing Call
by Monique Tello, MD, MPH, Instructor in Medicine

I was on call for our practice recently. My husband was traveling, I was alone with the kids, it was close to bedtime, and I had just given them a bath.

As we were upstairs in the bathroom, I heard my pager go off downstairs. (Yes, mistake number one- I left my pager downstairs!) There I was, toweling off two wiggly giggly squeaky clean kids, and there’s a page for me that probably has to do with a patient who I know is in the emergency room.

So I went into speed mode, and started grabbing all the things I needed to get the kids dressed: diapers, cream, PJs…. And then I smelled something.

Now, neither of my kids has ever pooped on the floor before. There’s been pee. But I have never seen either of them squat and just poop onto the floor.

And that is exactly what my 20-month-old little girl Maria did right then.

I gasped and froze. She looked at her handiwork, and then... reached out to touch it.

“AAAAIGH!!!!” I screamed.

“POOPIE! POOPIE!” My 3-year-old son Gio was jumping up and down, yelling and pointing.

I managed to restrain my daughter, swipe it up with a tissue, and drop it into the toilet.

Meanwhile, BEEP went the pager from downstairs.

Ugh.

If you’re a doctor-mom who takes call, then you’ve been there. That pager always seems to go off at the most inopportune moments; and the kids always seem to act up when you’re on the phone. Or maybe your call requires rushing into the hospital. What do you do?

I never feel like I handle my call weeks very gracefully, and I can always use the advice of my colleagues. So, I asked around to see what experiences and advice other doctor-moms have.

Internist and mother K. J. shares that:

“ Usually, I love calling my patients back from home. They seem so grateful and often cut short conversations that would often last longer if they felt I was at work. I have a memory of Joshua (2.5 years) and Noah (10 months) playing well one day when I was paged at home. I could not hear well on the phone. I closed myself in the bathroom to hear the patient better. Then, I heard a loud crash. The boys had knocked a glass lamp off the table. It shattered everywhere and they were standing amidst the glass. I told the patient I would call her back - which was not until about twenty minutes later. Luckily, it was not a time-sensitive issue. The patient was apologetic for bothering me at home!”

Obstetrician and Gynecologist and mother of seven-year-old Jack and 2.5-year-old Vanessa Holly Khachadoorian agrees:

“I have definitely returned patient pages with a screaming kiddo in the background. It’s a little distracting, but I think patients understand and are just grateful for the call when you are trying to balance your responsibilities.”

But is there a better way? K.J. writes: “I prefer to never be alone with the kids when on call. I make sure [my husband] is always around.”

Many of us try to have husbands, partners, or even our parents around for our call weeks. Radiation Oncologist Torunn Yock, mother of two, ages five and seven years old, describes:

“ I have been super lucky with call and my husband picking up when I am pulled too many places... I think ahead and schedule [call] for my husband to be around when I am on call. I will also fly in my parents or [my husband’s] parents when available.”

Internist Sandhya Rao, mother of 6-month-old baby girl Meera, also brings her parents in when possible: “I specifically invited my parents to come visit for my last call week. [It] worked out really well. I am doing it again for my next call during Christmas week.”

Rochelle Walensky, infectious disease attending and researcher and mother of three school-aged boys, is on call six weeks a year. She prepares as much as possible, but counts on a supportive partner as well as job flexibility:

“Generally when I’m on call, I know way ahead of time, and devote all of my time to the hospital; getting home for any event/dinner is a bonus. So, most of these conflicts largely arise when there is an unanticipated concert, school event, conference or something that I didn’t plan for. These almost always happen, and [my kids] are now accustomed to my ‘service’ time and that I’m not often available. When absolutely necessary and possible, I go in early or [plan to] stay late, and duck out in the middle of the day to attend. My husband also knows that he’s ‘on’ for home that week so he is always there representing both of us, if I can’t be.”

OB/GYN Khachadoorian takes overnight call in the hospital, as well as phone call at other times. She takes advantage of technology:

“Some of my strategies are to try my best to call home just before I'm on call to connect with my kids before the night gets crazy. I think it helps both myself and my kids to just hear each other's voices even if it is only for two minutes... They love giving kisses through the phone and updating me on their day.”

And texting works as well:

“I always hate missing my son's soccer games when I am on call... But what is really cute is Jack thinks it is totally acceptable for my hubby to ‘just text me when he scores’ so I won't miss anything! Thank goodness for technology!”

Miriam Bredella, specialist radiologist and mother of two boys ages 5 and 7 years old also takes advantage of technology when she has to go in:

“Netflix. In radiology, there’s usually a free computer around, and I’ll bring my boys in to work with me when I have to read cases. Since we limit television during the week, streaming Netflix cartoons is a very effective distraction!”

However, sometimes needing to go in on short notice can cause problems. Bredella describes a recent call when a spine biopsy had to be done urgently:

“My older son was playing in a soccer game, and I was watching from the sidelines along with my younger son. I got a page that the patient was ready for the biopsy and I had to go in. Luckily, the game was being played only across the street from the hospital. A parent I knew agreed to watch my son, and I alerted the coach. The biopsy was of course very complicated, and I was very stressed, wondering how long the game was going to be played. When I got out, the game was over and the parents were gone; even the coach had left. But the boys were fine, playing soccer by themselves in the field!”

Torunn Yock also occasionally has to go in on short notice. She enlists trusted neighbors: “Occasionally, I just take a chance... I talk to neighbors in the event I have to go in and my husband is out of town. I’ve been really lucky, knock on wood!”

Helen Delichatsios, internist and mother of two girls, ages 11 and 14 years, is more concerned with managing the everyday surprises:

“In my job, it's not so much when I'm 'on-call' that issues arise. Just general life-work balance, for example, having to deal with family issues when I'm in the middle of every day patient care. The main issue is the unexpected (sick child in the morning, call from school to pick up child, last minute school events) and the like. The key is having a back up plan - spouse, family, neighbor, who can deal with the unexpected....and having some built in flexibility in the job.”

All of these stories are validating, and the suggestions are solid. So what about that page I was trying to get to on my last on-call week?

The beeper was beeping and Maria had just pooped on the floor...

I quickly wrestled Maria into her diaper and PJs. My son Gio is usually easy to get dressed, but that night, he was determined NOT to wear a diaper. He turned and twisted and bent and giggled and I could NOT get the diaper on him. It was comedic: me snapping the diaper down and then re-adjusting it and him laughing and giggling and wiggling away…

BEEP went the pager.

Finally I snapped. I got right down in my son’s face, and I yelled as loud as I possibly could, so loud that my throat hurt: “LET ME PUT THIS DIAPER ON YOU NOW!!!”

THAT made my son hold still for a moment. And I put that diaper right on him.

We managed to get downstairs. I put on the TV and ran to my pager. I answered the page; it was the emergency room. The ER doc was filling me in when:

BANG! CRASH! WAAAAAAAHHHH!!! Legos went flying and my daughter started screaming. So there I was on the phone with the ER doc, and as I picked Maria up and held her, with her SCREAMING, both me and the ER doc realized this was not going to work. We couldn’t hear each other.

“Listen,” he said, “take your time. Call me back. I’ve got two little kids, and I’ve been where you are. No worries.”

“Thank you,” I said, truly grateful, and I hung up to soothe my daughter. After some hugs and cookies, I was able to call him back and discuss the patient.

Ugh. I still feel bad about yelling at my son... What did I learn from that experience, and also from all of this input from our colleagues?

SUGGESTIONS FOR BETTER MANAGING BEING ON-CALL:

1. Job Flexibility. Having understanding staff and colleagues is key. Sometimes, you just have to be home with a sick child.

2. Plan ahead. Have a partner, trusted neighbors, or even parents present, or at least aware, and ready to take over child care on short notice.

3. Take it easy. Don’t over-schedule when you know you’ll be on call. Lighten your load.

4. Use technology. TV is a wonderful distraction when needed. Phone calls and text messages keep us in touch with our loved ones when work duty calls.

5. Calm down. It’s easy to get overwhelmed by competing responsibilities. Take a deep breath.

** My on-call story was adapted from an essay that originally appeared on my own blog in June 2013, www.generallymedicine.com


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October 2013

Making it Better: A Faculty Mom's Ongoing Pursuit of Balance
by Shana L. Birnbaum, MD, Instructor in Medicine

My practice manager walked into my office, closed the door, and sat down. “How can we make this better?” she asked.

I promptly burst into tears. Big, drippy, sleep-deprived, mother-of-a-4-month-old-on-a-sleeping-strike tears. Internship and residency had done nothing (nothing!) to prepare me for the reality of working 7/8 of a full-time academic medical job while mothering a newborn.

That’s not to say that I didn’t learn important lessons during residency—I did. For example: when on a rotation, or given an admission, or even hit for an overnight ED shift in the middle of an outpatient GI elective, do the work, do it well, smile, and be nice to people. Don’t complain, at least, not excessively. After a call night, eat a big bowl of cereal regardless of time of day, and sleep at least 14 hours straight—if this means sleeping until returning to the hospital, that’s ok.

When my first son was born in the summer of 2007, I was a full 5 years out of residency. My residency skills were serving me well. I was having fun with my patients, had great clinical support staff, and colleagues who laughed a lot. I loved precepting my residents, enjoyed teaching medical students, and felt incredibly grateful to have found flexible work with the PCOI website that allowed me to write and edit from home one day each week. I was working hard, as I expected, but I had time to run, to read novels, to cook real food.

I understood that I would need to make substantial adjustments to my schedule after the little man we’d been calling Bubba arrived. I planned to add 30 minute “pumping breaks” to any patient session over 3 hours. My annual Bigelow month coincided with maternity leave: no more attending. I decided to stop teaching medical students—magically, my Monday afternoons were free, and without a medical student, my Thursday afternoon sessions could return to ruthless efficiency. We interviewed nannies, and found one, highly recommended, willing to show up at our house at 7am, and stay until 6pm twice a week. I can do this, I thought. I would even have one day a week at home with the baby!

And then the barely believable concept of Bubba turned into the reality of Zach: eight pounds of squirmy infant who instantly, passionately, became the center of my universe. Despite the exhaustion, I loved being home with him. I joined a new moms group, and had adventures that I wouldn’t have been brave enough to try by myself. I became competent, and then confident, as a mother. So quickly that I didn’t notice it happening, my primary self-identity shifted from “doctor” to “mom”.

Still, I never considered not returning to work—I couldn’t imagine not being a doctor. So when Zach was 12 ½ weeks old, I packed up my breast pump and some baby pictures, got into the car, and cried all the way down Storrow Drive. I survived that first day, and all the subsequent ones, and so, of course, did Zach. From my perspective, however, survival was all it was. Despite what had seemed like major changes in my schedule, I found that I couldn’t see patients, write notes and follow-up letters, return phone calls, pump 2-3 times a day, and leave the hospital in time to get home by 5:30 or 6. The very thought of an admission nearly gave me a panic attack. PCOI was a constant afterthought. Driving home, I felt a visceral rage at cars in Kenmore Square blocking the road home to my baby. And did I mention that that same beloved baby had begun an overnight sleeping strike soon after my return to work?

I was trying to do what I’d perfected in residency: do my work, smile, and don’t complain. But I felt like a terrible mother and a terrible doctor, and despite sleep deprivation far worse than any I’d experienced during residency, there was never an opportunity to eat a bowl of cereal and go to bed for 14 hours.

To be asked how to make it better was a revelation. A totally mind-blowing revelation, although in retrospect painfully obvious.

So with the help of my very supportive practice, I considered my options. Trying to be scrupulously honest with myself, I thought about what I could realistically accomplish in a given amount of time. I thought about which days of the week routinely brought me to tears, and what elements of my job gave me pleasure. And we made some changes—simple ones, like extending my pumping breaks and eliminating double patient sessions in a single day—that got me through that first year able to enjoy both my family and my work (which is not to say that they did not, both individually and collectively, drive me crazy at times).

Fast forward a year. Bubba #2 was on the way. A bit terrified that I would soon be faced with a 2 year old and an infant, I took stock of my priorities, expectations, and goals long before his arrival. This time, I was the one who walked into my practice manager’s office, closed the door, and sat down. “I’m pregnant again,” I told her. “And this time, I’d like to take 4 months for maternity leave.” To her ever-lasting credit, she instantly congratulated me, smiled through slightly gritted teeth (I could see her mind whirring over coverage), and told me we’d work it out. We agreed to several changes, including one that would allow me to work from home one day a week. We also broached the touchy topic of inpatient coverage, eventually leading to a broader discussion and mini-revolution within our practice, in which several of us have opted to use the hospitalist service.

When baby Cameron arrived, he fortunately lacked the sleep terrorist qualities of his older brother. It may have been that, or my veteran mom status, or my carefully crafted post-maternity leave schedule, but when I returned to work after my second maternity leave I felt none of the angst and heartbreak I’d experienced the first time. I missed both boys, certainly, and struggled like all working parents with too much to do in not enough time, but somehow the guilt that I was “missing” their childhood had faded. I appreciated my professional identity, and was actively enjoying the adult interactions I had with colleagues and patients during my three days a week in the office.

This September, Zach started kindergarten. “Baby” Cam turned 4 on his first day of prekindergarten. As they have grown from babies to toddlers to school-age big boys, their needs and schedules have continuously evolved. Just when I think I have it figured out, it changes. Abruptly. Completely. Sometimes with warning, sometimes without. So I am learning to continually evaluate, prioritize, and tweak my schedule, in search of that elusive work-life balance (does it exist?). I recognize how incredibly fortunate I am to have both financial and professional flexibility, along with supportive practice management that has not only allowed but encouraged me to make changes when I’ve needed to.

It’s a cliché, but a true one: I’m a better doctor for being a mom, and I like to think that I’m a better mom for being a doctor. I’ve come to accept that I can’t do it all—the seasonally appropriate decorations that appear in the yards of my stay at home mom neighbors and friends will never show up at my house. And I’m chronically behind on my patient follow-up letters, and I take too long to answer phone calls. But last week as he left the office, a patient thanked me for taking the time to explain things to him. Another called to say how much she appreciated my calls and care during her recent breast cancer diagnosis. The residents on my PCOI writing elective are getting some amazing guidelines posted on the website. And just this morning, I walked my boys to school, the three of us crunching through colorful leaves in our rain boots.


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September 2013

MGH Doctor-Mom: Managing Child-Related Sleep Deprivation, Part 2
by Monique Tello, MD, Instructor in Medicine

In Part 1, I described how I fell asleep driving on 93 South due to chronic sleep deprivation, after 15 months of waking up multiple times a night with our toddler, Maria.

We weren’t quite sure how we’d ended up there, but that’s what everyone says. Our oldest, Gio, had been magically sleeping through the night from age three weeks or so. We didn’t do anything special to make that happen, so we figured Maria would eventually follow suit.

Um, no. Doesn’t work that way. To make that part of the story short, my brush with a potential serious car accident scared the crap out of me, and we got serious about sleep training our baby girl.

So, how do you do that? Specific instructions can be difficult to find, and everyone’s situation is different. Erin Flynn Evans, PhD, sleep researcher at NASA, mother of two young children, and sleep consultant at ISIS parenting offers the following advice:

“When you have a young child who isn't sleeping well, it is always good to make a game plan and take action. For some parents this will mean sleep training, but for others this just won't be realistic or feasible. I think that some parents can't face a sleep intervention, because they are far too tired to implement anything with any consistency. Inconsistency can lead to moving from a situation that is barely manageable to disaster. I would offer the following tips:

1. Make sure the sleep environment is cool, dark and quiet. Darkness is critical
    for circadian entrainment. Making these changes is easy and in some cases
    can make a big difference.

2. Write down a plan. It can be something restrictive and fast or it can be
    something gradual and incremental. In either case, you need to write it down
    in order to remember what to do and to stay motivated.

3. Start the plan when you and your partner have the greatest number of
    consecutive days available to commit to the plan.

4. It usually gets worse before it gets better. It is hard for children and babies
    to accept change, so even if you are taking a gradual approach it may be very
   difficult to get over the initial hump of learning.

5. Stay consistent. Your plan is your way of communicating a new way of doing
    things to your child. Think of interaction you have at night as part of a non-
    verbal dialog. If you change your response during the night, then your child
    will have a very difficult time understanding what you are asking him/her to do.     Consistency is the most important factor in any plan.

6. Seek help. If you just don't have time to do the research or are so tired that
    you can't face making a plan, then consider working with a sleep consultant
   to help you develop a plan that fits your parenting style. It's important to find a
   reputable resource for assistance.”


For resources, she suggests the phone-based sleep consultations at Isis Parenting (she is a consultant) or in-person evaluation at the sleep clinic at Children's Hospital in Boston. She also advises that while there are many individual sleep consultants listed on the internet, it is wise to look into credentials, as some of those folks do not have any meaningful qualifications.

Back in February, while my husband and I didn’t have this advice, we did research the heck out of the issue, and we also asked our intrepid pediatrician what to do.

We learned that it was not only us, the parents, who really, desperately needed a predictable bedtime and a good, full nights’ sleep. Maria, the baby, needed it as well. We weren’t helping her growth and development by allowing her to have poor sleep. Once we came to that realization, it all clicked.

Our pediatrician outlined our main options: establish order quickly, or establish order slowly. Either way, our baby was likely going to cry. He mentioned that a recent long-term study looking at different sleep methods found that there were no long-lasting bad outcomes.

We chose the simplest, fastest method there is to establish bedtime and nighttime order: Cry it out.

I had been firmly set against letting her cry it out, mostly because I couldn’t believe that it wouldn’t have some sort of bad outcome. But, it doesn’t. It’s ongoing chronic sleep deprivation that probably has the worse outcomes. According to the October 2012 study in Pediatrics,

“Behavioral sleep techniques have no marked long-lasting effects (positive or negative). Parents and health professionals can confidently use these techniques to reduce the short- to medium-term burden of infant sleep problems and maternal depression.”[1]

Fortified by this scientific data, we attacked the overnight awakenings first. We just stopped going in to her when she cried, and miraculously, she started sleeping through the night. It took approximately three nights. And yes, it was messy (she vomits when she gets upset) and painful (who wants to hear their baby cry?). It was very hard, those first few nights, NOT to go in to her when she cried, and then to clean up a mess after she was asleep. I admit, I cried. But we stayed consistent.

AND it worked. After only a few days of a full nights’ sleep Hubby and I felt like we’d started antidepressants. Or uppers. And Maria herself was much better rested, more peaceful and cheerful. We were punching ourselves for suffering for so long.

Then, we attacked bedtime. We decided to establish a nice routine and a set bedtime, and to hold firm. The routine is a warm bath, followed a warm bottle, rocking in a chair and reading some books; then we put on bedtime music, turn on a night lite, put her to bed and walk away.

Yes, there have been relapses. She has gotten sick, and when your baby is coughing up phlegm, you just have to go in to her. Then there was a family trip… Yes, we have had to re-sleep train, and yes, there was more puking. Overall, we all sleep through most nights.

Hearing Dr. Flynn-Evans advice now, and looking back on our own experience, I can see that while everyone may need a slightly different approach, consistency is the key. Kids thrive on predictability, parents need a plan to follow, and everyone needs good sleep.

-------------------------------------------

[1] Price AM, Wake M, Ukoumunne OC, Hiscock H. Pediatrics. Five-year follow-up of harms and benefits of behavioral infant sleep intervention: randomized trial. 2012 Oct;130(4):643-51. doi: 10.1542/peds.2011-3467. Epub 2012 Sep 10


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August 2013

MGH Doctor-Mom: Managing Child-Related Sleep Deprivation, Part 1
by Monique Tello, MD, MPH, Instructor in Medicine

Like most doctors, I considered sleep deprivation to be part of the deal when I applied to medical school.

I’m sure my stories of pushing the alertness envelope sound familiar: During my Med/Peds residency (which for me started just before new residency work regulations were officially adopted) this meant many 24 to 36 hours shifts on the old q3 and q4 call schedule. I (vaguely) remember starting an ICU shift at 6 a.m. one day, and then searching for my car in the hospital garage at 6 p.m. the next night… For the life of me I couldn’t remember where I had parked. Only, when I did locate my old Saab, it didn’t start. Then I needed to wait for AAA to give me a jump, and then I still had to drive home, only to be back in the ICU the next morning at 6 a.m.… I’m sure I cried that night, but I don’t remember. I was too tired. I didn’t, however, fall asleep driving.

During my clinical research fellowship, I moonlighted on the Hospitalist service, often signing up for 24-hour Saturday shifts (hey, had to start paying off those medical school loans, you know), but found myself nodding off at my desk, trying to keep up with the weekday clinical and research work schedule… I didn’t, however, fall asleep driving.

Now, as an attending in Internal Medicine here at MGH, at 5 outpatient clinical sessions per week, I am aware that I have a much lighter clinical duty in general than many of my colleagues. My overnight duty is limited to answering the very rare late-night page.

So, why is it that the only time in my entire career that I have fallen asleep at the wheel, was just this year?

It was February. I was driving home from clinic, and I was (of course) stuck in Boston traffic, and I did, really, JUST FOR A SECOND, fall asleep.

I startled awake and realized I was dangerously beyond exhaustion. I was very afraid that I would fall asleep at the wheel on 93 South.

In that moment I went into survival mode: I opened the windows (it was bitter cold), and I called my husband to talk to me until I got home. Okay, in hindsight, talking on a cell phone while driving is never a good idea, and while driving fatigued, probably even worse. But honestly, traffic was moving at a max speed of about 15 mph, and it kept me awake.

But, the real issue: Why on earth is someone with a nice part-time day job falling asleep at the wheel?

Three words: Baby. Not. Sleeping.

At that point, our precious little toddler Maria was still waking up once, twice, three times a night for a bottle. And it had been going on for 15 months.

Looking back, I realize that I personally minimized the effect this chronic sleep deprivation had on me. The tendency is to “suck it up”, to laugh it off, to assume that it’s just something one has to deal with.

This can be a dangerous assumption.

Erin Flynn-Evans, PhD, is a sleep researcher who is passionate about this issue. She knows a thing or two about sleep: as a fellow at BWH, she participated in multiple sleep-related research projects, including the landmark 2004 NEJM article showing that eliminating interns’ extended overnight ICU shifts significantly decreased errors, the one that resulted in mandatory resident work-hours reductions by the ACGME.[1]

She is now leading the Fatigue group at NASA, and she a mother of two young children who also works as sleep consultant at Isis Parenting:

“In general, I think that responding to children at night is much more difficult than working, because you do not have control over anything. When you are at work you can prioritize, plan and delegate. You can anticipate problems and provide directions to nurses and staff about when to page you in order to maximize your sleep consolidation. When you have a young child you have no control over when you will wake and your sleep becomes fragmented and highly disrupted at random times.”

In a recent profile by the Boston Globe, Evans described that even as an expert, she’s constantly challenged by her 2-year-old son:

“I thought I knew everything about sleep, but he’s putting me through the wringer."[2]

This was very validating to me to hear. I am not the only doctor-parent who has suffered sleep deprivation due to kid issues, and you’re not either. It doesn’t have to be a baby waking up at night. Kids get sick, there are strings of nights up late or repeatedly dealing with croup, fevers, GI bugs…. there are late-night ER visits.

So, what do we do when you are seriously sleep-deprived secondary to baby/ child care issues, and we have a full day of clinical care, ten tons of administrative work, and a huge project in the works? We can’t call out. Not an option.

So in this Part 1 of how to practically deal with the very common situation of a practicing physician up at night with a child, we will concentrate on self-care. (For sleep-training your child, see the soon-to-be released Part 2):

These suggestions on self-care in a sleep deprived state are from my own personal experience, as someone who couldn’t hire a night nanny (doubt many of us can) and finding myself needing to figure it out:

1. Don’t minimize the issue. Chronic sleep deprivation is a serious issue.

2. Schedule yourself lightly, be it lower clinical expectations or putting off     meetings and projects. For me, this meant not taking new patients for
    a few months, and putting off teaching responsibilities and other projects.

3. Delegate as much as possible. I know there are times I give my staff 
     more work than I would otherwise, but it keeps the clinical piece
     together, i.e. no patient care falling through the cracks.

4. Be kind to yourself, physically and mentally. For me, this means eating
    healthily and exercising as much as I can; making time for friends
    and family; and not feeling guilty about any of the above.

5. And, yes, sleep training your child is a necessary thing.

See the upcoming Part 2 for advice on sleep-training your child!

-------------------------------------------

[1] N Engl J Med. 2004 Oct 28;351(18):1829-37. Effect of reducing interns' weekly work
hours on sleep and attentional failures.Lockley SW, Cronin JW, Evans EE, Cade BE, Lee CJ, Landrigan CP, Rothschild JM, Katz JT, Lilly CM, Stone PH, Aeschbach D, Czeisler CA; Harvard Work Hours, Health and Safety Group. 2
[2]Sleep researcher examines the mystery of shut-eye.” by Cindy Atoji Keene.


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July 2013

Welcome to the MGH Dr. Moms Forum!
by Monique Tello, MD, Instructor in Medicine

Let’s start with a quiz:
Which of the following scenarios is totally normal?
A. You’re at home with your kids, and on call. You get a page that you
     know will require time and attention. Even though it makes you cringe,
     you flip the TV to the show most likely to mesmerize your kids so you
     can answer the page in peace.
B. You keep your medical journals in the bathroom because that’s the
     only quiet private time you have the chance to read them (without
     falling asleep).
C. You’re checking your work email while breastfeeding your infant.
     Oops-now you need to wipe breast milk off your computer keyboard,
     and the only reasonable option within reach is a breast pad.
D. You’re in the midst of a busy clinical day, with a crammed schedule
     of complicated cases. You don’t have time, but you call home, just to
     hear your kids’ voices.
E. All of the above.

And the answer is E, all of the above. And yes, I have been to these places, and more…

Welcome to the MGH Dr. Moms Forum, a series of articles about being a doctor and a mother, a mother and a doctor… It’s not clear what comes first, in our overlapping realities. What I have learned is that I can’t imagine not being either. Or both.

I’m a part-time general internist in a practice that primarily serves women. It’s a great fit for me, personally and professionally, and that was almost completely by accident.

I came to this gem of a practice in a serpentine fashion, passing first through a Med/Pedsresidency at Yale with a goal of working in international health, then a fellowship and MPH at Johns Hopkins with a clinical and research focus on the care of women with HIV. This was a cozy immersion in the world of grants and papers and conferences, until...

At age... um, let’s say closer to forty than thirty, I realized I wanted to have a family. Actually, the desire to create a family hit me like a case of idiopathic hives (which I have also had). It was impossible to ignore.

Right around then, I had the extreme fortune to meet my future husband (online dating: ask me about it!).I gathered my thoughts, readjusted my life goals, and we decided to move back to Boston, where my family is, to start a family. I came here to MGH, we got married, and today, I have two beautiful little kids: a 3 year old boy (who also happens to be autistic) and an 18 month old girl.

And so it is that I am a doctor, and a mother.

These separate callings can compete with each other… huge responsibilities regularly tug us in different directions, and our attention can be divided, in ways that push our limits to a point of desperation… or hilarity. Depends how you look at it.

It’s very important to point out that these callings complement each other. So many of my patients also love a child: they are mothers, fathers, aunts, uncles, grandmothers… Many comment on the photos of my kids above my desk, and always from a point of warmth. Sometimes a story is told, a moment of shared experience, that takes us out of the clinical realm for a minute, and helps create or sustain the bilateral empathy that is so essential to the art of medicine. I have patients who I have followed for four years now (my whole attending clinical career thus far), and who themselves have followed me through my wedding and two pregnancies.

Writing about this experience keeps me sane, and some folks find it helpful/ entertaining as well. I hope that you’ll look forward to some of the topics that will be coming up in the near future, and that you’ll contact us if you would like to contribute your own writing to this space.

Dr. Mom’s Upcoming essay topics:
- Sleep deprivation and Dr. Moms
- Sleep training your child
- Flexibility in the workplace: essential for Dr. Moms
- How to take care of sick people when your child is sick
- Suggestions for building your support network

 

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