Motherhood as a female physician has been an incredible journey so far, overall. It’s gratifying, joyful, and exhausting. It’s a rolicking sort of balance. I love it. But I’ve noticed that working moms get a lot of subversive messages that can make us wonder if we’re doing a good job or not. There’s a lot of talk about overwhelm and mom guilt in the media. It’s true, I work more than 40 hours per week as a surgical subspecialist. And I’ve felt “cheered on” at times as a working mom. But many times, I have felt pressured to be as close to a stay-at-home mom in my free time as I can, and that’s a recipe for burnout. I’m here to tell you that if you choose this life– the life of a doctor mom (or dad), you will need to decide how you feel about it, ideally without the interference of others. You can’t let those societal messages hijack your brainwaves. It’s way too easy to let others’ opinions steal your joy, and you don’t have to let that happen. I’ve decided to reject parts of the societal narrative on mothering in order to create my own definition. And I’m a great freaking mom. Here’s my perspective on how my being a doctor really affects my kid. 

He’s learning about a profession centered around helping others.

As my kid transitioned from diapers to the potty, and words to sentences, I wondered when he’d come to know what I did for work. He’s four, and I thought this revelation might come later, at 5 or 6, as he gained some awareness of different occupations in the world. But it happened earlier, when I introduced the book, “Is Mommy a Doctor or Superhero?” by Dr. Amy Faith Ho, an emergency physician. It has really helped him get him acquainted with the idea of having a doctor mom. This book explains why mommy sometimes has to leave late at night to go to the hospital, something he’d started to notice happening. Sometimes his dad has needed to take over for bedtime, as I’d head out to embolize a bleeding organ. Wes was fascinated by the scenes in the book, and excitedly asked to read it again and again. 

It warmed my heart to see relatable scenes in the book, like mom getting patient related calls at the playground. The book illustrates nurses and patients on the other end of the phone. This helps explain the doctor-mom life so well, in simple terms that kids can understand. 

One of Wes’ favorite parts of the book is when the little girl can tell if her mom had a good day or a bad day. There have been times I came home and cried after a hard day. Through seeing my emotion, and with the help of our reading, Wes is able to cultivate an understanding of his own emotions, and hopefully, empathy. 

Our social circle really affects my kid. 

Being a physician exposes my kid to a network of amazing people he might not otherwise know. One of them is his pediatrician, who is a friend we get to see on a regular basis. She is part of a special group of kind, brilliant, and understanding moms, all of whom are physicians or married to one. Were it not for my line of work, I might not have assembled such a group of friends. We were brought together by the common lifestyle of the physician/ professional mom. 

It’s true that my current position occupies more hours of the week than I’d like right now. I plan to tweak that in the future, especially as Wes needs me more. But for now, I don’t dwell on the hours we are apart. I can see countless benefits of his spending time with the various people in his life. They are his whole village, and he’s learning more from all of them than he could from me alone. We have our own special bond as mother and son, and that bond doesn’t require a certain number of hours to maintain it. Nightly bath time, bedtime, and so many other times are ours. Consistent quality time and an amazing community really affect my kid. 

I provide, and that affects my kid

As the breadwinner in the house, my work not only helps others, it helps us too. My kid has a roof over his head, and chicken nuggets in his belly. Because of my toils, my son will grow up with a level of privilege experienced by about 1% of kids in the world. Is that a good thing? I think so. We have a lot to teach him about the responsibility that comes with that privilege, and we will have the resources to put toward the effort as well. This will have a massive effect on my child as he grows and enters the world as an adult. 

One day, I hope he’ll be proud as the son of a doctor

I was inspired by this tweet from a fellow interventional radiologist, proclaiming his love for tumor ablation, and his pride in sharing his win with his teenage son. I can imagine such an exchange with my little boy in the future.

Cryoablation of renal cell carcinoma. Nearly always curative, this is one of my favorite #irad procedures.

These patients are thankful their urologist referred them to my clinic.

Telling my kids I cured a person’s cancer today? Priceless. @AmerUrological @SIRspecialists pic.twitter.com/1OxM7VeeN7

— Peder E. Horner, MD Interventional Physician (@IR_Doctor) November 9, 2021

My little sprite doesn’t yet know what cancer is. But I look forward to the day when I can tell him I killed someone’s cancer. Doctoring is worthwhile work, and seeing us live this way benefits our kids and their development. So if you have kid(s), or would like to someday, don’t let a medical career stop you.

You may not be room mom, or make cupcakes from scratch– or maybe you will, if you choose to prioritize those things. Through your actions, you will model one of the many ways in which to live with purpose and meaning.

Loving your kid(s) doesn’t have to conform to a schedule. You can love them in a thousand of ways, and it’s okay if some of the traditional moves don’t fit into your doctor-mom schedule. There are so many ways to love my son, I know I’ll be doing them for the rest of my life. 

So I ask you to consider this: what if it’s not just mom guilt, heaviness, and sacrifice, the way it can be painted sometimes? What if what we do during the day inspires our kids? No matter the path they take, our example will stick with them for years, maybe through their entire lives. My being a doctor really affects my kid, but not in the way some would assume.

When I stop to think about it, what more could I want for him?

I hate repeating myself

It’s an impatient quality, but as a physician, wife, mom, friend, etc– I wish everyone could just hear me the first time. With a surgically-oriented personality, I would love to convey things in the most efficient way possible. As in, “Blade!” or “Kelly, please.”  So when I’m asked to repeat myself, I feel my inner voice protesting, “This is so inefficient, argh!!”

Usually, if someone repeats him or herself, my inner voice wants to inform them, “I heard you the first time!” But lately, I’ve considered changing my tack. It’s possible the individual repeating himself is trying to tell me something, and I am not quite getting the message. As a new strategy, I’ve tried to come up with a different response each time an idea is repeated. It can serve to smooth the social interaction, and clarify the idea being conveyed. This trick of changing your response came to me when speaking with a family friend suffering from Alzheimer’s disease. Now, I can use it in daily conversations.

Consider the benefits of repeating yourself. 

So in an attempt to do everything better, I’ve taken to repeating myself more on purpose.  Here are some reasons why.

It can help your relationships! For example, if I assume I will need to repeat my message to communicate effectively with my husband, I’ve managed my own expectations. If a message is conveyed the first time, that’s a bonus. Otherwise, repeating myself can be more like a baseline expectation. He’s got other stuff going on, after all, and even if we understand each other, we all get distracted and forget things. Repeating myself is the (modest) price I pay to get an idea from my brain to his.

My little boy is 14 months old, so repeating myself with him is a great way to teach him our language. I repeat words and phrases with as much variability as I can. Sometimes, I’ve realized, repeating myself comforts him. I sing the same lullabies when he’s struggling to settle down for a nap or fighting a diaper change. My singing the few Czech folk songs I know helps him learn a few words and be comforted by a part of his heritage.

Repeating oneself as a tool for doctors

Repeating can be a really useful strategy at work, too. Patients and families need plenty of explanation around the diagnoses and treatments we recommend. They need to know the risks and benefits of a given procedure or course of treatment. Before the patient even arrives for a procedure, they are inundated with information on the hospital floor. It’s even more difficult and stressful for patients to assimilate information when they are acutely ill. Therefore, they’re not in the best position to grasp all of the information we provide. This is why repeating yourself can be helpful. Having family or friends at the bedside is also key. It allows for the benefit of repetition, with the help of others who’ve helped to absorb the information.

Every time I repeat myself in a slightly different way, I’m working on my own communication skills. This is really important as an early career physician, but I suspect I’ll be working on these skills for a lifetime.  

Using more words as social anesthesia  

Depending on the person, and perhaps as a function of my communication style, I find many want to hear more from me, not less. Patients are in a vulnerable place, and they often want the space between us filled with words. It can be soothing to repeat some elements of your consent, or to phrase things in different ways, to help a patient understand. Reiterating, clarifying, and soothing the patient in this way can build trust between you, and can function as a form of social anesthesia.

Fleshing out an explanation with as many simple words, phrases, or descriptors helps to depict the journey a device will take from the groin to the belly in an interventional procedure. Showing a deployed vena cava filter within an acrylic model, or drawing a diagram of the arteries below the knee goes a long way in bridging the gap between a physician and patient.

Repetition is part of masterful communication

I recall listening to my attendings as a trainee, marveling at the masterful use of words to describe the pathophysiology, mechanics and solution to a particular problem in simple, understandable language. Translating to lay language is a skill, and an art form all its own. And the most skilled attendings would repeat important elements of the discussion.  

Sometimes, as physicians, we can be overworked, over-caffeinated, and just too busy to slow down or repeat ourselves. But using this strategy is making me a better partner, mother, doctor. So, at the risk of repeating myself… give it a try!

Don’t forget to check out the Mastermind Retreat for Women in Male-Dominated Fields. During this unique retreat, we’ll unlock strategies to improve your work and your balance. The retreat is now eligible for 6 Category 1 AMA PRA credits through Rush University! Use your CME fund to join us for this transformative wellness retreat in my beautiful neighborhood in Palm Springs, California.

After almost five years working together, a colleague, a diagnostic radiologist, moved to be closer to his parents. “We don’t have that much time left,” his parents said, weightily. As a dutiful son, he complied with their wishes, selling his house, and uprooting his little family to move hours away. And just like that, I lost my supportive work spouse. 

At our trauma center, he was a workhorse, squeezing joint injections and barium studies between interpreting scans of brains, bellies, joints, and everything in between. Working at a constant pace, he was indispensable. I will take over arthrography duties in his absence, and I’ll be thinking of him.  

My work spouse and I enjoyed short chats between cases, strolls to tumor board, and afternoon tea. These breaks were part of our “wellness ritual,” we joked. Physician burnout is a hot topic these days, and most radiologists don’t have time for lunch away from the monitor. So reminding my work spouse to leave his desk felt like a small act of service. These breaks served to loosen our limbs and clear our minds, just for a few minutes.  

We talked about the tea selection, and about switching from coffee to water. We griped about the hospital grub, with fried food and Monster drinks among the consistent offerings. Discussing the diet of the week, I told my work spouse about the breastfeeding diet, which allows you to eat whatever you please, including doughnuts. He kindly assured me I didn’t need to worry about it.

A work spouse will discuss the mundane aspects of the day.

A cold here, a backache there. We chatted about the mundane.  And there are only certain people with whom one can discuss such things. This is the virtue of a work spouse.

Sometimes we talked about travel- he and his (real) wife were always coming back from somewhere exciting, like her homeland, Ireland, or Japan, or Patagonia. But mostly, we talked about abscesses and visceral artery ectasia and the beverage of the day.

An ally at work will recognize you, just for doing your job

“You’re always so calm,” he’d say, when inside, I felt anything but. It was just what a busy interventionalist wanted to hear in the middle of a stressful day.  We consulted each other’s opinion throughout the day, and had a mutual respect for each other’s role in caring for patients.  

When I was pregnant, my husband was on tour for weeks at a time, traveling with a popular jazz ensemble. Bob woke up somewhere new each day. His days were filled with new places and interesting people. At home, I felt out of sight and out of mind. During that time, my work spouse was there, day after day, asking how I was. Later, when I was ordered on modified bed rest, I was restricted to working from home. In my isolation, I could rely on my colleague to answer a “hello” over the instant messenger, or offer an opinion on a difficult case.

My work spouse was a fixture in our lives.

Over the years, as other professionals and friends came and went, my work spouse was woven in the fabric of our social group. We belonged to an extended work family.

If you can find such a supportive and symbiotic relationship at work, I recommend you cultivate and appreciate it.  I know I’ll miss my work spouse.

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There is something wonderfully shameless about taking my one year old out on a Saturday night in Palm Springs. A friend having an engagement party at a restaurant says it’s okay to bring my baby, so I do. Baby refuses his afternoon nap, and becomes a tiny mess of a human just before we leave. Should I can the whole thing? Do not give up. For a moment, I’m emotionally exhausted from his unmet needs I can’t figure out. I attempt “quiet time” for Baby while getting myself dressed. I must move forward. After installing the car seat and hoofing our clunky stroller into the trunk, I choose to disregard the layer of dust on the car. Drive to the party spot and park a couple blocks away to avoid the valet, and to prime the child with a little walk.

Erm, excuse me…

Eking the stroller between diners, their dogs, and tennis courts, I find an elevator. We are making it! I see an uneven set of stairs- and tuck the stroller off to the side of an empty dining room.  Where will I put my 21 pound child?

Balancing my 90th percentile baby in my hypertrophied left arm, I cradle a glass of wine in my other hand.  I chat with acquaintances, and attempt a greasy pork dumpling. Grease runs down the back of my hand, but no matter. I am a super hero, and things like this don’t bother me now. (If it can be wiped away to the point that it is not visible, it no longer exists.)   Somewhere between the child, the glass of wine, and heels in the grass, someone says, “Wow, that’s impressive.”

I did not realize what I’d become used to was impressive, and feel a ray of pride for moms everywhere, who do two- handed tasks with one hand all day.  In small ways, motherhood has been a surprise pedestal I didn’t know I could stand on.  I was afraid of motherhood-  with the trappings, limitations, judgments, expectations and cliches that came along with it.  Some women go from pregnancy to pregnancy because of the attention they receive from society, as though they are placed on a pedestal for carrying forth new life.  Now I wonder- 1 year in- does this special treatment continue through motherhood? I now have a ‘who cares?’ philosophy about a handful of things, which makes me feel a bit invincible. I can prioritize like a mother… I can leave the house without makeup.

Mom Compliments

I’m being called beautiful by people for the first time, as a mom. Maybe my heart and face are open now.  People want to talk to me, who never did before.

Motherhood is full of challenges and small triumphs, just like medicine, in my experience so far.

Has motherhood surprised you?  What’s the best Mom compliment you have received? Leave a comment below.

And if you want to stay in touch for more momspiration in medicine, join my mailing list by clicking here.

It can be a roller coaster, folks. This life of putting your hands, needles, and scalpels on people. A week in the life of a superheroine can be trying.

One week I am lauded for saving a life, and the next week, I can deeply disappoint patients and colleagues. That’s the way it is.  

A week in the life of a superheroine won’t destroy you… or will it

I just need a mantra at these moments: “I can’t destroy my reputation with one procedure.” 

That’s my hope, at least. 

No pressure, right? 

Of course, there is pressure. It’s peoples’ lives and limbs at stake here. 

Superheroines fall

So I messed up at work. Like I really made a really stupid, thoughtless mistake. I haven’t made this exact error ever before, and I haven’t made a comparable error in years. But when you do a thousand procedures, you might make a dumb mistake in there somewhere. It sucks, but it’s true. 

This error is something I did, and I did it alone. I confirmed the plan with the nurse in the room, and then 5 minutes later proceeded to do the procedure on the wrong side, and my assistant let me. It’s not his fault, he lacks experience, and probably couldn’t even see where I entered the skin, with the fluoroscope blocking his view.

I didn’t recognize my error until hours later, as I went to dictate the case. Right. I worked on the right side. The pain was on the left. My face flushed, and my head slumped into my hands. Fuck fuck fuck fuck fuck. No no no no no. Not on this patient. She had already been through enough. Why would I do this, when I should have been paying attention? Everyone matters and is theoretically equal, but if anything, I should have been hypervigilant in this case. This patient trusted me implicitly, and I let her down.  

Shame permeates a week in the life of a superheroine

I felt nearly incapacitated with shame for the rest of the day. I notified the department manager, who entered an incident report. Will they take my license over this? I don’t think so…

As often comforts me in these cases where the outcome is short of what I’d hoped, I tell myself, if no one died it’s going to be okay. The thing is, I told the patient there were serious risks, and then I proceeded to work on the wrong side as if I didn’t take it seriously enough. I stated the gravity of the rare (but real) risk and then disregarded it with my actions. 

I spent the afternoon trying not to hate myself for making a mistake. Trying not to blame anyone else, because that’s my go-to move when I feel vulnerable or hurt, is to blame. It is certainly not a tendency I’m proud of, and it’s one I’m actively working on. Blaming fills some kind of need in the moment, in a maladaptive way. 

No matter how you’re feeling, the day keeps moving on

I felt horrible making a mistake. Later that night, I was called in emergently to care for someone who was bleeding to death. I selected the bleeding vessel instantly as if driven by some sort of dumb luck. Incredible fortune, I thought. I was lauded by the vascular surgeon who came in for an update, just as I’d finished. I did my show-and-tell, pointing to my angio and embolization on the screen, as he admired my work.

“Great job,” he boomed. “You saved a life!”

I muttered, “After the day I’ve had, I guess I had an easy select coming to me…”

My new colleague and I exchanged phone numbers and parted ways. The patient was coming off blood pressure support. A victory, but in the shadow of my mistake. 

Putting one foot in front of the other

The next day, the victim of my error returned for her procedure: for another chance to get it right. She was gracious and listened to my apology. The case went well. I think it will help her. 

I returned to the ICU and the person I ‘saved’ the previous night is now on four vasopressors. She stopped bleeding but her heart couldn’t take the insult. Does this feel like whack-a-mole to anyone else? 

And riding the emotions of a week in the life of a superheroine can feel like being on a roller coaster. I’m not going to lie. In one way you’re up, in another way you’re down. It balances… sort of. If you’re a good doctor, you care… and people are sick. Outcomes can be good, bad, and everything in between. 

A rollercoaster of a week

And this is to say nothing of those who greet you at home, from your fur babies to your partners and children. They add other (mostly) wonderful variables to your life: they can make the roller coaster ride sharply turn left or right, as it coasts wildly up and down. 

Back at work, you can be a savior, a dunce, and everything in between. But this is the life we chose- a life of one challenge after the next.

“Why not?” we probably thought at some point. We are talented and bright, and we can do so much good. It’s just that in these moments– and in these tough weeks– the challenges overwhelm. The shame stings. We try to help people as doctors, and we’re not perfect, no matter how hard we try, or how much we wish we were.

I’m just being transparent. This is not a boring, stable life. Not for me, not this week. This is a week in the life of a superheroine.

If you are feeling some similar way, I’m sending my solidarity and hugs to you, superheroine. 

When we become doctors, we install a new operating system. Or maybe it’s installed in us, depending on your perspective. There’s the hardware we start with: the brains, drive, and talent that help determine our potential. Then, we superimpose this system from which we operate, that will set us apart for the rest of our lives. If you leave medicine, maybe you’ll miss some system updates, but I think remnants of the doctor OS will always remain. There’s no going back once it’s in. And there is a reason many other staff members in the hospital don’t work or think the way we do. They don’t have the same OS. You may as well hear it now. I was surprised. Because becoming a doctor means installing a completely new operating system.

As a doctor, you’re different… permanently.

Many people come to healthcare with the same compassion and drive as budding doctors, but with a different intent. They buy into helping others, but not at the expense of themselves. They haven’t been indoctrinated with the same self-sacrificing ethos as we have. It’s called residency, where they reinforce this OS, bolstering it with firewalls against our alternate realities. But the installation starts in medical school. That’s when the idea of holding your urine as long as possible, or at least until the end of this study module is installed in your psyche. Putting your needs aside becomes your modus operondi. You’ll get coffee as an excuse to move from your study cubicle.

On rotations, you learn that you don’t eat if there is work to be done. You certainly wouldn’t stop to eat while you’re halfway through an operation, so you may as well get used to ignoring that need. Food is really just a “want” anyway, right? We learn to “eat when you can,” or “sleep while you can,” and that attitude bleeds into the rest of our lives, too. The doctor OS dictates when it’s appropriate to perform other self-care activities too. Because food and sleep were primary concerns until you got your new OS. It’s only natural to believe that other needs are even farther down the list. So sometimes you don’t see your own doctor for a few years. This system teaches us to put ourselves last, so it’ll be your job to reinstall self-care in your life. It’s not part of the doctor OS, and it might even mess with some of the scripts.

Work is the rule on your new operating system

State labor laws and union rules don’t generally apply to physicians, but they do to other disciplines in healthcare. Our operating system prepares us for this fact, I guess. We don’t have any (true) hour limitations or mandated breaks as physicians. We don’t get to just “go to the dentist,” as our administrators do.  

When we install this medical OS, I think we uninstall or purge some of our old OS, to make room in the old memory, for these new ways of operating. That’s why you will never be the same after medical training. You may as well accept that now, wherever you are in your path towards becoming a doctor. There’s no going back really. 

Becoming a doctor: you’ll never be the same

You will never be the same after medical training. You learn through standardized test-taking that comprehension and seemingly infinite shades of correctness require such a precision you’ve never known before. When a small mistake could mean harm or death to a patient, it’s only natural we operate in such an exacting way. We sacrifice nights, weekends, and holidays in the name of this work, as our OS hums in the background. The work of a doctor has a weighty, gravitational pull that affects lives and families, and ironically, our families might never understand. They won’t understand if they’re not in medicine. Our operating system allows us to take on an extreme amount of responsibility, beyond even that which is in our power to control. It’s almost inhuman. And it can be inhumane. 

The challenge in becoming a doctor

But you’ll still need to work with others on a different operating system. They will punch out as you’re struggling to care for every last patient. They might have a vague idea, but not truly understand the responsibility you hold. They’ll think of their feelings first, but you can’t. They’ll call you demanding and difficult. You’re not– but you are on a different OS. And you know the stakes demand it. Others don’t know how many nights you’ll lie awake if there’s a bad outcome, but it’s the shadow we live in as doctors. And we think, “If I just flagellate myself a bit more, it’ll be easier to stomach if anything bad occurs.”

This is the default, and the challenge of moving through life on a physician operating system. Ours is a high-speed, intricate data cruncher, and a driving program that doesn’t allow for much rest… not as much as other humans, anyway. As we move in an imperfect system in an imperfect world, it’s not easy being on the doctor OS you’ve received. Patients and their families hold high, sometimes supernaturally-high expectations, and often, we deliver, thanks to this operating system driving us. 

Just don’t expect others to think or act like you, because they are not on the same system. And don’t expect you’ll ever be the same once your new OS is installed. 

Welcome back to the blog this week! I just pulled off my first ever in-person event, and I wanted to share what that was like. In October, I put together the first-ever Mastermind Retreat for Women in Male-Dominated Fields. Approaching a retreat like this– taking on a responsibility of this magnitude feels analogous to the training we go through to become doctors, and it’s probably analogous to life in general, too. So what was it like to run my first retreat? It was new. It felt a little bit like planning a wedding, which I have done before, but there were many aspects that were new. There was COVID-19, and then the surge passed, and things seemed to calm down. And then we surged again. The vaccine came on the scene, and this retreat I’d wanted to plan seemed reasonable again. But still, it was a risk. Here’s what it’s like to have a dream, take a risk, feel the fear and do it anyway.

Feel the fear and do it anyway

Running an in-person event is a big deal. Let’s just say, I have a lot of credit card points now. There was a financial risk. Just booking a small hotel for 4 days- it was almost five figures. There was a risk people may not show up. After all, there were a lot of steps involved: booking a flight, getting on a plane… There was a risk people would get COVID19, as one of my speakers did. Since she was feeling up to it, we pivoted to a virtual presentation, making our event a hybrid one (voila!). There was a risk people wouldn’t vibe, or wouldn’t share their experiences, making the experience fall flat. I experienced all these fears for the better part of a year as I brought this retreat idea to life. With so many risks, why do it, you might wonder.

Nothing like this retreat has existed, to my knowledge. There are other trips to expensive spas, targeting physicians who need to throw some money at the problem: namely, their chronic stress. But I saw a gap and felt compelled to fill it. I wanted to create my own space and experience for women in male-dominated fields because our challenges are unique. So compared to those other physician wellness retreats, my aim was a little different. Yes, it was important for attendees to be able to relax. But the most important component was gathering a specific group of women who are normally isolated in their professional and thereby often their personal spheres. I wanted to provide a forum for this specific group of women so that they could have the conversations they needed to have. They live with common questions and challenges, often having just tiny corners of time in which to explore and address them. We were hungry for this retreat. It needed to happen, and I knew that in my core. So I felt the fear and kept marching forward.

Failing and fearing forward

Did I feel like I was failing along the way? Yep. It was a lot of fun to put together, and I knew I had a lot of value to share. After all, I’m the local expert in a pretty cool place. So I had some confidence to help me through my fear of failure. As I booked the venue, the caterer, the entertainment: I had to have confidence. But the possibility of failure haunted me throughout the process. I obstinately pushed forward, focusing on serving my people, and making this the best experience it could be.

To get people to sign on to come, I had to market the thing for nearly a year. And I’m not actually a marketer! I have tried to learn what I can in my spare time, and I applied that to spreading the word about this retreat as I planned it. Thanks to some sponsors, I was able to make the retreat a reality without emptying my own accounts. But there were months in which no one showed enthusiasm for it, and I wondered if I was making a mistake. I felt the fear, then dismissed it. I was creating an experience I thought had the potential to change someone’s world. And it did. 

Feel the fear: It doesn’t have to win.

Finally, the month before the retreat, I started getting little notes here and there, from these busy women, telling me how excited they were to come to Palm Springs, and how they were looking forward to it. Some of these were from people I had yet to meet in real life, like Dr. Stephanie Pearson, a long-time supporter of this blog. I sent packing lists. I confirmed our catering, our transport, and our park guide. Made sure we had a yogi and masseuse. I confirmed all the location details and figured out how to get CME accredited. (Thank you, Rush University!)

As I put one foot in front of the other, I figured out how to work a projector for the first time, and set it up in the California sunshine– that part worried me for weeks! Thank you, Alvaro, my intern and tech support guy, who found a projector screen in great condition on Craigslist, so we could display all the incredible information presented over our four days together. 

Can you enjoy something despite the anxiety it provokes? I think so.

As per my catchphrase, “save lives, enjoy your own,” I was determined to enjoy this thing. After I confirmed the key players, printed the itineraries, and sent the final emails, I enjoyed the crap out of my retreat. Yeah, I shuttled trinkets and yoga mats and leftover food to and fro, but I was also present. I relaxed. The beauty of the attendees and the environment surrounded me like an embrace. I was able to give all my attention as I witnessed real, lifelong connections being forged. We lacked connection during the pandemic, and we can feel it’s lacking in the male-dominated fields of medicine and surgery.

I’m grateful for my retreaters’ presence and their trust in me. I’m glad I felt the fear and kept going anyway. 

You confront fear on the regular. You’ve got this.

I bet you know what it’s like to feel the fear and do it anyway. After all, you’ve signed up for organic chemistry, knowing it’s a weed-out class. You’ve studied for hours a night, knowing you could fail. You show up to medical school, knowing you’ll need to memorize reams of material. And you show up to your intern year like a lamb for slaughter, hoping to aid suffering and treat disease with compassion. 

As an attending approaching mid-career, I show up to my next case not knowing the anatomy I’ll encounter or the challenges we’ll find. I come to work not knowing the next mass casualty or administrative edict that could drop at any time. I still feel that fear, years after training, but it’s different now. The retreat reminded me what it was like to dive into the unknown– to feel the fear and do it anyway. Oftentimes, when we do this, we are handsomely rewarded for it. 

I hope you are rewarded this week. You don’t have to be fearless, but you can feel the fear and do it anyway. 

The first-ever mastermind for women in male-dominated fields created a cocoon of safe space to discuss real challenges we share across specialties. In male-dominated fields, we can often find ourselves to be the only woman in the room. When we are lucky enough to encounter another person like us, we may have only five minutes together, as we exchange hellos in the bathroom or conference hall. There’s usually not enough time to connect on a personal level or speak about the sometimes sticky situations we can face in fields traditionally lacking in diversity, whether in gender or otherwise. During our four-day retreat, we had ample opportunity to share experiences across a range of practice locations and experience levels. It was our own mastermind addressing topics including diversity, equity, and inclusion in the traditionally male-dominated fields.

Diversity, equity and inclusion: a moral imperative

Sometimes the lack of diversity, equity, and inclusion (DEI) can affect our morale. It can directly affect the people we see around us: the person who opted out because they didn’t see anyone who was black, brown, LGBTQ, shorter than average, or any other version of “other,” like them. But DEI can be tangible, too. 

A resident at the retreat brought up an interesting example. She shared how there was no radiation protection lead apron that fit her properly at her institution. The “resident lead” was a relic from years past. It was far too heavy for her, and it was ill-fitting. They simply did not have an appropriate lead apron for a person with a small frame. She put on the ill-fitting garment and experienced back pain that very day. There was no way she would consider becoming an interventional radiologist. It was clear she did not have the constitution to stand in lead all day. At least, that was her first impression.  

Show, don’t tell: when you care about diversity equity and inclusion

Nonetheless, this resident was interested in image-guided procedures, and wanted to learn as much as she could during her rotation. So she tried to advocate for herself and those like her, requesting the program provide a small lead-equivalent garment. This could be shared by people rotating through the department. But her program declined (to put it politely), saying there was other lead for her to use. But that lead was a suboptimal one-piece design, not the two-piece design recommended for better radiation protection and decreased back strain. 

Not having the right protective equipment available is short-sighted. It’s well documented that lead aprons should be well-fitted to prevent musculoskeletal injury. Surely people rotating through the department would be of varying stature, not just the size of an average man. Especially these days, when women outnumber men in medical school classes (for the past couple of decades). Surely having a small lead apron available would benefit the department for years to come. But the program admin didn’t invest in a smaller lead apron. What a shame.  

How to Stand Up for Yourself, and for Diversity Equity and Inclusion

This resident and I had a conversation about the physical demands of the field of interventional radiology, and fields like it. I emphasized the importance of lead that fits. Furthermore, contemporary “lead” aprons are much lighter, using materials like barium, tungsten, tin, and antimony. This makes lead equivalent aprons 20–40% lighter than standard lead aprons. 

After speaking with me, she decided to buy her own lead apron, a significant investment on a resident’s salary. When she put on the apron fitted to her small frame, she was shocked. There was no back pain this time, and she was now prepared “to work a 12-14 hour day, no problem.” She could now enjoy her IR rotation and experience what it was like to do the work, without the distraction of ill-fitting or excessively heavy lead. This has allowed her love of IR to blossom, and now her career trajectory is straight into IR. It’s astounding to think that this person, a trainee of the highest caliber, nearly disqualified herself from her intended career based on a lack of appropriate equipment in the department. And the responsibility of having this equipment should not be on the trainee. The responsibility belongs to her hospital and program administrators. 

A ubiquitous challenge and clear target for improvement

I think back to my own experience rotating through various parts of radiology. There was a somewhat random assortment of lead available. Not infrequently, an XL was the only size available. I’m sure someone thought it could ostensibly protect “everyone,” be they large or small in stature. You wouldn’t want a large person in a lead apron that was too small, or their radiation protection would be inadequate. So, as an average-sized female, I’d don an XL lead, and wrap the straps around my body, tying the velcro straps in a bow in front, since these large aprons were too oversized to use the appropriate velcro closure on the hips.

We make do with what we have. For short procedures like a barium swallow, poorly fitting lead might be okay. In a couple of minutes, you’d be out of the lead and back at your desk interpreting studies. But in surgically-oriented fields like IR and surgery, in which we can stand and work in these garments for hours, their size actually matters. 

People wonder why we don’t see more women flocking into fields like these. This example illustrates why. If we want to increase the number of women entering fields like interventional radiology, interventional cardiology, vascular surgery, or orthopaedic surgery (among others), we need to welcome them. Making appropriate protective equipment available is one way to do that.

Improving DEI: It’s not such a mystery sometimes

Let’s do less talking and theorizing about how to improve the pipeline of diversity in the demographically skewed fields of medicine and surgery. Instead, let’s take a look at the tangible, everyday ways in which we can support the next generation of physician colleagues. If we listen, they’ll tell us what they need. And that’s what happened last week at our mastermind retreat. Ideas and solutions were flowing. 

So what can you do? If you’re a resident or medical student and you notice this problem in your department, point it out to someone who can do something about it. At my institution, a department manager employed by the hospital orchestrates the measuring and ordering of protective equipment for everyone. At a training program, you may need to contact your Program Director. Find out who’s in charge of ordering lead and help them understand the need you identify.

If you’re a fellow or attending, you should have your own lead fitted to your specific measurements. Assuming you do, take a look at your supply of “guest,” “resident,” or “student” lead. Does it only accommodate a certain body type or stature?

While protective garments are adjustable to a degree, there should be more than one size available. If the only size available is large, you have a problem. If you don’t have more than one size lead represented, or if the guest lead is over a decade old, speak to your administration about it. You can order contemporary, lighter lead aprons to help prevent long term musculoskeletal problems.

To accommodate an increasingly diverse workforce, encourage your decision-makers to order a few different sizes of protective lead aprons, at a minimum. Having lead that fits different bodies is the kind of inclusion you can FEEL. The future of your field depends on it. 

It’s up to you, too

What tangible opportunities for improvement do you see in your department, hospital, or workplace?

What tangible steps have you taken to support diversity in your practice? Share in the comments section below!

To see an example of what a fitted, 2-piece lead apron looks like, and how you put it on, check out this video:

Well hello! It’s been a busy time getting ready for the first-ever Mastermind Retreat for Women in Male-Dominated Fields, but I’m back on the blog with an exciting guest post. This week’s blog comes from Dr. Carol Yuan-Dulair, a board-certified physician in pulmonary critical care, internal medicine, and sleep medicine. She started a sleep service for women that helps them get better sleep and live better lives. She even named the program after her daughter, so sweet! I hope this post from Dr. Yuan-Dulair helps you consider any hang-ups you may have regarding your sleep so that you can secure a better snooze!

– TiredSuperheroine

The Rules Were Not Created for You

I’m a rule follower. Maybe it’s a means of survival in the world of medicine. But for women in male-dominated fields like medicine, often, the only rules you find are those created by men for men.  

To give you an example, I returned to my work as a pulmonary intensivist after just five weeks. This amount of maternity leave is inhumanely insufficient, and I do not recommend it. This ‘choice’ came from a combination of my naivete and the pressure I felt as the only female in my group. For context, when I first told the partners I was pregnant and requested time off in advance, one of them responded coldly, “I wish I could be pregnant.” 

As soon as I got back to work following maternity leave, I realized the inherent conflict between following the rules of a man’s world and being a “good mom.” Heeding guidelines and recommendations, I was determined to provide my child with exclusive breastfeeding for 6 months. The only problem was that the ICU rounding schedule didn’t seem to respect my lactation needs. There was always another procedure, STAT situation, or family meeting before I could sneak away with my heavy, conspicuous pump bag to the lactation room, which was located on the other side of the building. 

Trying to meet a woman’s needs in a male environment

Usually, by the time I got to the bare, windowless room, milk-soaked through my undershirt. There, like Diana Prince transforming into Wonder Woman, I unleashed the biological power of my womanhood. With the pump’s mechanical hum echoing off the walls, I finally caught the glorious sight of filling milk collection containers, which hung off my topless body. As I pumped, I worked, of course, a phone wedged between my ear and shoulder, as ten fingers typed furiously on the keyboard.  

Meanwhile, my male colleagues seemed blissfully ignorant of these challenges. One time, a colleague called to discuss a patient while I was pumping. The pump made a cyclical alternating groan in the background. Hearing the noise, he asked what I was doing. I thought he would realize, not just from the noise over the phone, but because he was a new parent himself.

“I’m pumping,” I answered.

“Where? I’ll come too,”  he said.  

I was shocked.  Not sure what he had in mind, I stuttered, “Why?”  

“I haven’t worked out in a while. I can do some weights too,” he replied. He didn’t have a clue about my challenges as a breastfeeding mom, and unfortunately, some male-centric sleep guidance is similarly inadequate when it comes to addressing women’s unique needs and challenges.

Some Sleep Rules that Could Thwart Your Sleep

There are many sleep “rules” we’re told to follow in order to secure a better snooze. Take them with a grain of salt.  

“Sleep hygiene” consists of a popular set of sleep rules, with a peculiar name, in my opinion. What does sleep have to do with cleanliness? While clean bedding and good air quality are certainly key to a comfortable night’s rest, sleep hygiene as a set of behavioral rules first appeared in the book Current Concepts: The Sleep Disorders, by Dr. Peter Hauri. 

The original version of these rules came out in 1977:

• Sleep as much as needed to feel refreshed and healthy during the following day but not more. 
• A regular arousal time in the morning strengthens circadian cycling and finally leads to regular times of sleep onset.
• A steady, daily amount of exercise probably deepens sleep; occasional exercise does not necessarily improve sleep the following night.
• Occasional loud noises (e.g. aircraft flyovers) disturb sleep even in people who are not awakened by noises and cannot remember them in the morning. Sound attenuated bedrooms may help those who must sleep close to noise.
• Although excessively warm rooms disturb sleep, there is no evidence that an excessively cold room solidifies sleep.
• Hunger may disturb sleep; a light snack may help sleep.
• An occasional sleeping pill may be of some benefit but their chronic use is ineffective in most insomniacs.
• Caffeine in the evening disturbs sleep, even in those who feel it does not.
• Alcohol helps tense people fall asleep more easily but the ensuing sleep is then fragmented.
• People who feel angry and frustrated that they cannot sleep should not try harder and harder to fall asleep but turn on the light and do something different.

Today, if you Google “sleep hygiene”, 175 million results come up. The advice ranges from intuitive: “Get into your favorite sleeping position,” to questionable– “Use your bed only for sleep and sex.” Why is sex okay, but not reading? Isn’t exercise supposed to be bad at night? There’s also a range of caffeine and alcohol advice. But is the cut-off at 2, 4, or 6 hours before bed? It can be confusing and even anxiety-provoking to follow all these rules, which can of course be counterproductive.

Sleep rules don’t guarantee a better snooze

Earlier this year, when the American Academy of Sleep Medicine published the latest clinical practice guidelines, there was a collective sigh of relief over their recommendation against the use of sleep hygiene for chronic insomnia.  The opinion agreed with what most sleep clinicians have observed– that sleep hygiene alone doesn’t work. The academy added: “Clinical care devoted to sleep hygiene as a single-component approach may impact the availability of clinical care devoted to more effective…treatments.”

Here are a couple of my personal observations to add: 

Rules can add to a feeling of frustration.  

It’s frustrating when you’ve done all you’re supposed to do, but you still can’t sleep. My neighbor, Diana, is a successful entrepreneur who owns and operates a medical spa while holding a corporate position as well. Her regimented bedtime routine included getting off all electronic devices one hour before bed and donning blue-light-blocking shades to eliminate a potentially sleep-disrupting exposure. She goes to bed at the same time every night, following a half-hour of yoga and meditation. Once in bed, she tries to fall asleep under an expensive weighted blanket, a Christmas gift from her sympathetic husband. Her routine made her feel frustrated. Not only was she still bone-tired from not sleeping, she felt she had done all there was she could to combat her insomnia. She came to me at the end of her rope.   

Rules foster competition

Recently after watching the movie Space Jam, my son became interested in basketball. Obligingly, I enrolled him in a basketball class. On the first day, the coach gave him A Beginner’s Guide to Getting Started in Basketball. I found it surprisingly similar to the advice I give my patients.

1. Get into the correct gear (I.e., wear comfortable night clothes)

2. Warm up the correct way (Wind down before bed) 

3. Start jogging, cycling, or walking everyday (Daily physical activity helps better sleep)

4. Make sure to have fun (Try not to stress over a bad night) 

Sports statistics depict a measure of performance. Similarly, today’s technology has turned sleep, once intangible and mysterious, into a measurable behavior for individuals. Smartphones and watches measure sleep stats, like sleep time and deep sleep percentages from detected body movements. The data is crunched through proprietary algorithms, and flashes on the screen as sleep scores are plotted into charts and graphs, just like sports statistics. Could this be counterproductive?   

Potential competitors in the sport of sleep include bed partners, social media personalities, and purported averages presented as what’s “normal.” Sleep rules, like a playbook, are followed to a tee, as nightly success is attributed to effort or lack thereof. Competitive sleep is a slippery slope with insomnia waiting at the bottom.  

It’s true that restful sleep is the key to your competitiveness. But fundamentally, sleep is as natural as night following day. It’s as biological as the exhale following the inhale, and as necessary as the breathing that sustains life from the first cry to the last breath. Sleep is intrinsically unique from one person to the next.

Discover your sleep identity to secure a better snooze

Your best sleep is anchored in the knowledge of your own sleep identity. As Lao Tzu, the ancient Chinese philosopher and the founder of philosophical Taoism said:

“Knowing others is wisdom; knowing yourself is enlightenment.” 

Lao tzu

If you don’t know your sleep, then all the sleep rules, sleep hygiene and sleep statistics will be interpreted improperly. Without knowledge of your unique sleep personality, your sleep plan will be distorted, and likely ineffective, putting you at a disadvantage as each night begins.  

“What is your name?” and “Where are you from?” are two questions we commonly ask when meeting someone new.  We have come to understand the answers contain important pieces of information about our identity. We all know there is more to each of us than our names and where we live, but these facts offer a frame on which to hang our stories. Two equivalent questions to ask about your sleep personality are your circadian rhythm and your sleep hours.  

Circadian rhythm

Circadian rhythm is the natural rhythm of sleep in relation to the 24 hour day and night cycle and societal norms. One’s circadian rhythms can roughly be categorized as a tendency toward “early” or “late.” You may be familiar with the cliche of the early bird, or for those who favor later hours, the evening lark.  

Perhaps you know your circadian rhythm already or have a gut feeling about it. If you’re unsure, think back to the last time you were on vacation. What time did you go to bed, and when did you wake up? Being away from noise, stress, and the day-to-day grind, sleep on vacation can present in its most natural form. 

Sleep hours

The amount of sleep your body needs nightly should fall somewhere between 7 and 9 hours. Numbers outside that range can still be normal but may warrant a medical evaluation to rule out potential sleep disorders.  

If you want to be more precise, You can do an experiment called a “sleep vacation”. During a two week period, when you have a flexible schedule, pick a consistent bedtime, and don’t use an alarm to get up. For the first few days, sleep may vary as your body tries to adjust. Keep going to bed at the same time, and you’ll eventually establish a pattern that tells you the number of hours of sleep you truly need.  

In my experience, most people are familiar with their sleep identity. With varying degrees of success, we’ve been at it every night for our whole lives, after all. The problem arises when we get our sleep identity mixed up with various rules and expectations. Untangling this mess requires reinforcement of what truly matters, often with my help.  

When you know your sleep identity, the goal becomes matching your real-life sleep schedule as closely as possible. Execution can be tricky.  

What do I have to give up to secure a better snooze?

Sometimes, you need to be honest about whether you’re prioritizing ample sleep.

“I just want to have more energy to do the things I need to do,” Tiffany told me one day in between patients. A nurse practitioner with an affable bedside manner, Tiffany is a mom of three with a history of gestational diabetes. She is also a talented baker. Earlier that day, I nearly drooled on her phone when she showed me pictures of the Frozen-themed cake she made for her daughter’s first birthday.  

I immediately knew what she needed to get her energy back. I suspected she knew it too. She told me about her guilty pleasure going home to a quiet household after a long workday. It was just before the older ones got home and while her toddler took a 4-hour afternoon nap. In that time for herself, she loses track of the hours, as she researches cake recipes and responds to inquiries. Then, Baby, their youngest, wakes up.  

Will she ever get enough Zzz’s?

As it turns out, after her refreshing nap, Baby doesn’t go to bed until after 11 pm. And Tiffany forces herself to stay up late, crashing as soon as Baby goes down for the night. Then, in less than 6 hours, she drags herself out of bed at the sound of her 5 a.m. alarm.  

Tiffany knew she needed more sleep. At least an hour if not two. She used to have a lot more energy when she could sleep 7 to 8 hours before having kids, or even just before Baby came along. Yet with the knowledge and insight, she was not about to give up her “me time.”  She didn’t want to wake Baby up from her nap either, in order to get Baby to bed earlier at night. She was also hesitant to delegate Baby’s nighttime routine to her husband because she thought it was important that he had his alone time as well.  

Are you serious about securing a better snooze?

In pursuit of our best sleep, there may be sacrifices. It might be our control, beliefs, independence, me-time, or just plain time– there is no silver bullet. There’s also no right or wrong answer. Your choices will determine the best path at the time and in any given circumstances. The secret to securing a better snooze lies in following the unique blueprint that fits your goals and priorities.    

Because Tiffany chose not to give up her me-time and independence, she continued to “run on fumes” as she called it, for months after we spoke. Gradually, Baby grew out of the daily long afternoon naps. In the meantime, Tiffany, alarmed by her weight gain and mounting glucose levels, started heading to the gym after work. These changes led to an earlier bedtime and more regular sleep for the family. Tiffany’s energy level improved. 

“What about the me-time after work?”  I asked her one day. 

“Arghh…..” Tiffany expressed displeasure with the trade-off she’d made. “To make it up to myself, I stay up later on weekends and bake after Baby goes to bed,” she explained.   

The rule-follower in me was dying to bring up issues of social jet lag and total sleep deficit, but I stopped myself and nodded knowingly. Then cheekily I asked, “Got any pictures?”  

This post was brought to you by Dr. Carol Yuan-Dulair, critical care and sleep expert. Please check out her tips and program at https://www.bhaisleephealth.com/ !

Hi there! The Save Lives, Enjoy Your Own Podcast continues with an episode on doubt, and how to deal with it. Can you face down your doubts as you enter a competitive, male-dominated field?

In this episode, you’ll hear about the flavors and subtleties of doubt that can arise when you’re not entirely sure you belong in your field just yet.

I love to share the story behind the story in this podcast. This medium allows me to take you behind the scenes to hear about the things that didn’t make their way into the book. The book contains excerpts from interviews of women across various surgically-oriented specialties. Throughout the book, they share their experience and their tips to succeed in medicine, and they are pure gold.

The podcast to face down your doubt

Check out the podcast anywhere you like to stream or download. I’ve liked Apply podcasts and Overcast, and you can listen on Spotify using the embedded player below.

I would absolutely love to get more reviews. If you can find a moment to drop a favorable review, it would let me know you like what you hear, and help others to find the podcast, too! By leaving a review, you’re increasing the podcast’s clout. You can leave a review via your podcast app. Thank you so much for listening.

I hope you face down your doubts and win!

As I mentioned in the episode, you can sign up for my email list for periodic updates on ways to thrive in a male-dominated space.

If you’re raring to read the full book, Save Lives, Enjoy Your Own: Finding Your Place in Medicine, you can purchase a special signed edition here. And if you read and loved the book, please leave a review on Amazon to let others know it!

I appreciate you!

This week’s blog is a guest post from Allie Cooper, a freelance writer with a passion for financial wellness and mental health. Here’s her post on debt, and how the construct of gender affects the accumulation and management of debt in our society. Here’s her post on debt & gender equity. Enjoy! -TSH

Despite varying financial behaviors, debt between men and women is comparable in nearly all categories. For instance, men hold just $125 more in credit card debt than women as of 2019, although women have more credit card accounts than men. On average, men generally carry more debt than women: 20% more in personal loans, 16.3% more in auto loans, and 9.7% in mortgage loans. Taking all kinds of debt into account, men carry 21.7% more debt than women.

The exception is student loans. A recent study reveals that of the total $1.5 trillion student loan debt in America, women hold two-thirds. Even as evidence points to women being just as capable – if not more – at credit and debt management than men, the disparity in student loan debt persists. But the issue of educational debt involves more than just healthy financial habits: it involves systemic and cultural issues as well.

More women attend college than men

Fifty years ago, 58% of college students in the U.S. were men. By 2017, that proportion flipped, with 57% of bachelor’s degrees going to women. In today’s digital landscape, women dominate the online education space, as well, especially when it comes to higher education. According to a Business Women Media report, online learning is ideal for women. Online learning platforms remove some of the traditional constraints to attaining education, like location specificity and time constraints. It can provide a more flexible opportunity for learning.

The rise of remote learning comes at a time when many kinds of work can be performed remotely. More than ever, following the pandemic, companies are looking for flexible workers with digital literacy. Online business administration programs help learners become well-rounded professionals who can go into a variety of positions, including human resources management, accounting, operations, data analytics, and marketing. Taking these courses allow women to gain credentials, making them more appealing hires. Ultimately a wider range of opportunities increases women’s earning capacity, helping them pay off debt faster.

Women earn less than men

Unfortunately, degrees and qualifications still aren’t enough for women to achieve equity in the workforce; there’s still a considerable pay gap. A man with a bachelor’s degree still out-earns an equally credentialed woman by approximately $26,000 per year. Women in finance earn just $0.76 for every dollar a man earns. Even in jobs that employ more women than men, women are still paid less. For instance, diagnostic technicians make up two-thirds of the workforce, yet they earn $19,000 less than men every year.

The pay gap hinders women’s financial empowerment, and makes it harder for them to pay off student loans. One way to combat the pay gap is to negotiate. In a previous post, Dr. Barbara Hamilton discussed the importance of negotiation. Encouraging transparency and knowing your worth can help protect you from falling prey to the pay gap.

Reduced family support affects debt & gender equity

Financial education begins at home. Unfortunately, studies show that parents talk about money differently with their sons and daughters. In a Fast Company post, columnist Jared Lindzon highlights how 61% of boys are taught about credit scores as children, compared to only 46% of girls. He also points out how this disparate treatment extends beyond mere lessons; girls receive less money from their parents compared to boys from elementary to high school ages.

A recent survey showed that as a trend, parents save more money and are willing to spend more on their sons’ college education than on their daughters’. Indeed, these kinds of home-grown biases can impact lifelong earnings and financial health. As a result, girls tend to take on more student debt to cover their educational costs. A greater awareness around financial literacy and opportunity can help remedy these issues for girls in the future.

As society progresses, so should women’s standing within it. We need to recognize the interplay between debt & gender equity in our society. It’s only through equitable terms and opportunities that women can be more financially free.

Leave a comment below to share your own experience with educational debt, the gender gaps that persist today, or both. -Tired Superheroine

Allie Cooper is a freelance writer with a passion for financial wellness and mental health. She enjoys helping others become more financially savvy and spends her days reading about the best ways to achieve this. When she’s not working on a new piece, she’s often tending to her indoor garden.

If you’re not sure how to optimize your student loans, be sure to get your free consultation with Student Loan Planner. They’ve been a trusted resource in my online community, and have now advised on over one BILLION dollars of student loan debt. You can get more information about them and their mission by clicking here.

This is a guest post from my former medical school classmate, Dr. Yana Barbalat. She and I entered med school together as twenty-something year old sprites, and we have reconnected many years later over our love of sharing a positive message about working in our respective surgically-oriented fields. Here she is to share her own personal story. It makes my heart sing! Here’s her take on thriving in the world of urology. -Barbara Hamilton, MD

What’s it like to enter a specialty rife with dick jokes?

Tired Superheroine asked me what it’s like to be a female in the male-dominated field of urology.

It’s empowering, fun, and challenging at times. Being a female in urology makes me a minority in most professional situations and that’s a place where I happen to feel comfortable and thrive.

The origin story of a female urologist

Since I was born, I have been a minority. My family is Jewish and when I was born, we lived in Petrozavodsk, Russia. There were very few Jews, and antisemitism was rampant there. Thankfully, we immigrated to the United States by the time I was 8. As a kid in America, I found myself a minority once again, first because I did not speak any English and second, because we were poor. I dressed, looked, and sounded different which made elementary and middle school difficult, to say the least. But during those years, I built the resilience and work ethic that would serve me well.

As a young physician in residency, I was a minority once again. I had two children during residency, with the first one born two weeks into my intern year. For about five years, I was the only female surgical resident who had a family. At first, my goal was to blend in and not draw any attention to myself. I did not want to be judged poorly because I chose to have kids so early. But the reality is that residency was really difficult for me, not just because of the physical exhaustion but because of the constant mom guilt. Sometimes, I remembered an elderly lady who told me that urology was not a field for a woman with kids.

Doubts about entering the world of urology

There were many nights that I would walk the hallways in the hospital and think of switching into another field. But with the support of my husband and my parents, who never believed in feeling bad for oneself, I held on and focused on the future. I learned to sleep less, be more resilient, and feel less guilty for not being the perfect mom. Proud of what I was accomplishing, I found my voice and began to advocate for myself. I started to share my experiences with others. I told junior residents and medical students to have children when they thought the time was right, not when others felt it was appropriate. And for my own sake, I stopped feeling ashamed of working four days a week, with the fifth day OFF,  not on “administrative” duty.

Overall, I am really glad I picked urology. It’s a fun field with a lot of inappropriate humor. We use cutting-edge technology and cool gadgets- from lasers to prostate staplers, prosthetics, and robotic arms. As a woman, I bring a unique perspective to the table and I am somewhat of a wanted commodity because many female patients want to see only female physicians.

In a place to elevate & improve the world of urology

Being a woman also puts me in a position where I can advocate for women’s health in Urology. Pelvic pain, female sexuality, and recurrent urinary tract infections have traditionally been considered the less interesting topics in urology. Care of the female patient can be more time-consuming, and the visits typically don’t result in any procedures or surgeries. Adding to the challenges of caring for my female patients, the data on the management of predominantly female conditions is not robust. With more women going into urology, topics in female urology are being brought to the forefront, studied, and discussed more at meetings and events.

What are the challenges of working in a male-dominated field?

But being a minority can be lonely and can also put you at a disadvantage when negotiating equal pay and career advancement. Studies show that women in practices with other female urologists are more likely to be paid the same as their male counterparts, as compared to women with all-male partners. I think women in male-dominated fields should connect, mentor one another, and most importantly, support each other.

Hope this story of thriving in the male-dominated world of urology inspires you!

Push yourself, connect, ask for help, and don’t be afraid to be different.

I’ve been thinking a lot about worthiness. People talk about this in self-development circles, and I find it an interesting topic to explore when it comes to medical professionals like doctors. We are drawn to this service profession for different reasons. Some reasons are as unique as we are, while others are common. But my guess is when it comes to feeling worthy, you might be doing it wrong. I was. You see in medicine, many docs suffer from an arrival fallacy. We think we’ll be happy when we complete med school. Then, if that doesn’t happen, we’ll be happy when we finally get out of training. But sometimes the goalpost keeps moving, stymying our happiness. I think we do this with worthiness too. Here’s what I’ve figured out about worthiness in my medical career so far. 

Selecting for those who want to prove worthiness

Medicine selects a lot of high achievers, and there are plenty of reasons to achieve. For me, it was looking for the best way to ensure a secure position in the world, where I’d always be needed. Being able to help people in my work was an obvious bonus– I could learn to help people with my skills, giving my work a greater sense of purpose. I thought a medical career would impart a sense of social and financial security. In times of COVID-19, we learned just how insecure our positions can be. Nonetheless, I suspect medicine selects for competitive, driven folks, some of whom wish to prove themselves. And we think, when we become doctors, we’ll have arrived. We’ll be unquestionably worthy.  

Training is like cutting your teeth… on a meat tenderizer

Then, we go into training where we are beaten down a bit. We are corrected by everyone from our senior resident to the cleaning crew. I’m not exaggerating; it can be emotionally taxing. Meanwhile, we are just trying to keep up with the amount of information we must absorb and retain. Many of us don’t feel worthy at this stage. I certainly questioned my worthiness in the setting of my own training program. It was a competitive, grueling ride, and I often considered myself the dumbest one in my class. It’s an occupational hazard of surrounding yourself by smarties I guess. 

I shipped off to fellowship and on to my first job. After caring for some of the sickest transplant patients in the world, I felt like I could handle almost anything. Maybe I felt worthy. I felt grateful to land in a position at all, after a long job search in a tough job market. I felt lucky they took a chance on me. Now, it was my mission to prove my worthiness, in a new environment, with new rules.

Women’s worthiness in traditionally male spaces

Personally, I’ve noticed this worthiness question lurks under the surface. It’s sort of always there, affecting my interactions and my experience. I wonder if it’s an unexamined question for women like me, especially in male-dominated fields like mine. We have to prove we belong here: that we are just as dedicated as the guys. That we won’t take too much maternity leave. That we can be trusted and won’t have untoward complications. When we do hard things, it can tax our worthiness meter. 

Finding my worthiness

I’m working on finding my worthiness seven years after medical training. On the one hand, I know I have a tremendous worth. I save lives for heaven’s sake. And I make my bosses and the hospital plenty of money while I’m at it. I’m worth… millions or priceless or whatever. But I’ve seen physicians tie their self-worth to other people’s metrics, or other people’s expectations, and I think that’s a problem.

I lost two physician co-workers to suicide last year. Just at my institution. For one of them– the clearly intentional suicide– I wonder if his sense of worth and purpose were TOO wrapped up in his identity as a surgeon, and as he circled the final lap, preparing to hand off leadership of the program he’d built, he lost his reason to live. I think about him all the time. I wonder if our sense of self-worth makes us vulnerable to that biochemically-driven, clinical depression that can take us into a deep hole, beyond where rational explanations can save us. 

Why worthiness?

My foray into worthiness has come from delving into the semi-spiritual. Some believe we can create our biggest dreams by believing in our innate worthiness: we have a divine right to realize whatever we could imagine. It might sound far-fetched, but you can do this by believing in your worthiness. So it’s a concept worth at least exploring, whether it gets you that dream life or not. In my view, it’s worth just feeling… worth it. 

It means not questioning yourself all the time

As our kids run around the park, I chat with a gorgeous young mom, who tells me about about her days as a stay-at-home wife. Practicing my worthiness makes me more open to conversations like these. I don’t ruminate about how she cooks her kids 3 meals a day, and I could never do that. Her experience interests me. Here at the park, we are just moms. And there’s no one best way to be a mom- whether you stay at home or work outside of it.

I decided if you’re at the park having fun until dusk, you’re a good mom, and that is all. There are no organic snacks on my person; in fact, my kid is ravenous and eating all of hers. Just being with our new friends is fun. In the past, I might have ruined the moment with my sense of unworthiness. She’s a trophy wife, and no one would ever consider me that. In the past, I sometimes felt like being a doctor was my whole identity, especially when meeting someone new. I’d worry they would treat me differently, or pepper me with questions about their family’s ailments. This time, we chat about our vaccine status, and she asks, “Are you a doctor?”

I nod. “What kind?” 

“A radiologist.” 

My new friend asks what life was like in the hospital through the pandemic. Then, we move on to another topic. I am just myself, and she’s good company. I’m flexing my worthiness with all the people, and it’s a work in progress. 

You’re worth it

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