The prestigious Hospital Woebegone has launched a successful new course for female physicians entitled Inception 101. Inspiration for the course came from the 2010 science fiction movie Inception. In the movie, a professional thief infiltrates the subconscious minds of his targets, embedding new thoughts for a price. As in the movie, the goal of the new course is to make targeted individuals believe that newly implanted ideas are their own.

Implanted ideas promote equity

According to Dr. Blakemore, the physician who developed the course, “Inception 101 provides women in male-dominated fields the strategies they need to be recognized for their success. Given the ongoing inequity in medicine, we had to become more creative in how we leveled the playing field. Using our patented methods, women are finally getting the recognition, awards, promotions, and compensation they deserve.”

While the details of the proprietary method are secret, the basics involve consistent positive reinforcement and messaging about female staff. The goal is to permanently implant these ideas into their colleague’s brains. Critics may argue these techniques are not founded in science, but it is difficult to dismiss the effects. Since the course began, the percentage of women earning as much as their male colleagues is greater than at all nearby hospitals. The number of awards and promotions are now nearly equal between the sexes. There has been less turnover of female staff since the course began.

Implanted ideas are benefitting patients, too

The change has not been lost on the patients either. Patient satisfaction scores on recent Press Ganey reports have shown their highest customer experience ratings since the course was introduced. Turns out that happy staff translates to happy patients.

Not all employees are pleased with the new course. “It’s brainwashing!” complained Dr. Meathead, a male physician. He mansplained, “They’re pulling this Brave New World– type nonsense– playing recordings to us in our sleep. They send subliminal messages through tiny speakers that only the male ear can hear!” He dismissed the corrections that this is not at all how the process works, suddenly yelling, “Oh look! There’s an emergency!” cutting the interview short and briskly walking away. 

The how of implanting ideas in the medical mind

According to the syllabus, the course teaches women to support their female colleagues by utilizing several specific interventions. Techniques include repeating what other women have said in meetings or on rounds to emphasize their points, interrupting men who interrupt women to redirect the attention back to the woman initially speaking, and teaching ways to address daily microaggressions, among other patented techniques.

Dr. Blakemore addressed critiques from her male colleagues saying, “Our goal is to help women be recognized for their hard work and accomplishments. When our white cis male colleagues pointed out that we were being exclusive, we realized that we were -– just not to them. We now plan to expand our course to other traditionally marginalized groups. These include the BIPOC and LGBTQA communities.”

Implementing and implanting a better future

Other professional organizations are taking notice as well. Nearby law and business schools plan to develop their own versions of Inception 101. When a female law professor expressed concern about potential pushback from the male-dominated administrators, a leaked email from Dr. Blakemore revealed the following assurance: “Don’t worry, you’ll be able to convince them. There was initially a lot of resistance in the hospital too. You know the first place we employed our inception techniques? On our administrators! Trust us, your course will be approved in no time.”

Dr. Stephanie Benjamin is an emergency medicine physician and award-winning author based in Southern California. She took up journaling in kindergarten and hasn’t stopped writing since. Her first book, Love, Sanity, or Medical School, is now available on Amazon. You can find more of her writing at www.StephBenjaminMD.com. Reach out to her at StephBenjaminMD@gmail.com, and follow her on social media @StephBenjaminMD.

This evening I was walking around my house naked, prepping a bath for my little one, and vibing to the sound of James Bay on my speakers. At that moment my quality of life was 10/10. And I realized that quality of life isn’t just for the dying, it’s for all of us. Even doctors. 

QOL on a Monday night

As the music echoed through my home, I reflected on the dinner I’d just prepared, a few fish fillets from the freezer that flaked just right on my cast iron pan. A side of kale and risotto, chopped and prepped by someone else as a side dish. Feeding myself the healthy fare, I relished watching my little man eating mushrooms, marveling at the sight. I sipped sauvignon blanc as we grazed on a picnic-style dinner consisting not only of fish and veggies but the toddler snacks he’d already strewn across the table. The remnants of cheesy popcorn, hummus, and pretzels. 

After dinner, we ate the Ben & Jerry’s I’d grabbed from the hospital cafeteria before I left. It was the half-baked kind, and it was half-melted, yum. I divided it into two dishes, as my four-year-old melted down, whining that he wanted to eat it right from the container. Don’t we all, little buddy… don’t we all. I chose creativity over a battle of wills, setting most of it aside in the freezer, while allowing him to eat the rest right out of the carton, delighting his little face. That’s quality of life right there. A moment of pure joy. 

Quality of life in hard times

I’m actually going through a hard time personally, for reasons I might explain some other time. Suffice it to say I’ve been mourning. I actually hired a life coach who specializes in intentional living, with a background in palliative care. I want to live this life fully and intentionally, without regrets at the end. And I like the idea of being guided by 80-something-year-old Barbara– she’s crinkly, joyful, and still a bit sarcastic. She knows what’s best for me, and I can ask her for guidance. Some call this, “living with the end in mind.” Old future Barbara knows what really matters. She knows what quality of life is all about. It’s about those small, beautiful moments like tonight. 

The thing about valuing your quality of life, and allowing yourself to be guided by it– before any devastating diagnosis occurs– is that it requires accountability. Sometimes something in your life isn’t quite right. A situation or person is not right for you. You need to make a change, but that isn’t always easy. It can be heartwrenching. But think of that wise old lady inside. Love her, and take care of her. She knows what’s up.

Hyperfunctioning and quality of life

The thing about doctors, medical students, aspiring docs, is that we learn to hyperfunction. We learn about the ECOG performance status scale, which tells us a lot about a patient’s ability to care for themselves, and therefore, about how they might respond to treatment and their overall quality of life. Zero is the best score, meaning a patient is able to carry out all daily activities one would need or like to do. ECOG five is dead, and one through four are in between. For example, an ECOG 2 patient can perform activities of daily living like bathing, but they can’t work. 

Imagine if we evaluated ourselves on this scale as medical people. We’d be below zero, in the negative range. Because often, we are HYPERfunctioning. We aren’t just doing all our own activities of daily living, we are picking up those of the people around us. We’re an ECOG negative 2. And that’s not anything to brag about. 

In our world, full-time work means something different than it does for other people. We are just special that way, in a sort of overworking martyr-y kind of way. An FTE or “full-time equivalent” physician can work 80-100 hours. Yet some are ashamed to scale back to a 0.8 or a 0.6 FTE. I dream of it regularly. But it took me a while to get there, since we are indoctrinated to think that full time work is standard, no matter how many hours that entails, and that part time work is inferior.

Don’t overachieve yourself, and cheat yourself

Hyperfunctioning is a defense mechanism, and it’s one I’m looking to drop. It’s not our fault that we’re this way. This behavior gets us through school, and helps us achieve our dreams. We get results from this accomplishing and overdoing (hello, memorizing one book for a month, 10 hours a day in a gray cubicle over burnt coffee!).

We get results by planning our days and measuring our worth in how much hyperfunctioning we can fit in. And in school, in clerkships, heck, even in relationships, hyperfunctioning can seem to garner some great results. Maybe. At first. Then later, not so much. You see, hyperfunctioning can be maladaptive. It’s tiring. It’s not healthy. And it can degrade your quality of life if you’re not mindful of it. 

It’s part of our medical culture, so we’re swimming in it. But the thing is, while it may get you the results you want, it won’t lead to a great quality of life. Often, it can sabotage it. Why? 

Grit and the quality of your life

Because when things are rough, the answer in medicine, and for people like us is to grit it out. To try harder. If you’re trying to ace organic chemistry, it works. If you’re trying to run your social life that way? Not so much. 

Your quality of life matters, even if you’re not dying. I mean, technically, we are all headed in that direction, but you don’t need to wait until someone hands you a dismal diagnosis to value and choose the highest quality of life for yourself. 

No one else can do this for you. Not your advisor, your mentor, not your parents. Your quality of life matters, even as a doctor. Especially as a doctor. Because if you don’t care about your QOL, it can fall off the list. 

You’re not a machine, no matter how gritty you’ve proven yourself to be. 

And your enjoying the shit out of that avocado toast doesn’t take away an ounce of your grittiness. I’m just saying.

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!

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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.

Recently, I found myself solo parenting for 11 days. It inspired me to write this post about shortcuts. As doctors and perfectionists, one might wonder: are short-cuts allowed? Are they forbidden? Sacrilegious? We live in a culture steeped in parental guilt, which upholds practices from helicopter parenting to Pinterest- perfect parties. So how does someone with a demanding vocation handle parenting in this milieu? I’ve embraced cutting corners as a busy parent, that’s how. 

Cutting corners: the inspiration

I suspect no one wants to hear about a doctor cutting corners, and it’s equally forbidden to cut corners in child-rearing, I’m told (by whom? society?). Nonetheless, I’m here to talk about it because I think we need to manage expectations if we want (and want to be) relatively happy, well-adjusted caregivers. 

I was talking to a friend, Dr. Julie LaBarba, after recording a podcast together. She’s a pediatrician, nutrition expert, mom of 4, and most recently, a podcaster, as the creator of the Paging Dr. Mom platform. We clicked during our short virtual time together, which is unsurprising, considering she seems to absolutely exude positive regard for others. I enjoyed basking in it as we prepared for and executed our podcast interview. While I appeared slightly rumpled from a nap, Dr. LaBarba was coiffed and pulled together, looking like a gorgeous tomboy in a plaid top, from what I recall. My point is, that she exudes perfection. Not perfectionism, but perfection. And apparently, my imperfection inspired her. During our recording, I said something about embracing shortcuts as a way to thrive through the busyness of being a doctor, mom, creator, and so on. She perked up.

Days after our recording, she sent a sweet voice mail, saying I inspired her, or perhaps gave her permission to be a “drive-through mom” for once. As a lover of healthy cuisine, and as someone who educates others on the topic, she had not allowed herself to cruise through the drive-through for the quick fix, like… ever. If she was going to be “the fun mom,” fast food was not the way. But after our conversation on shortcuts, she did it, and to her surprise, she felt great about it. In a small way, she was embracing cutting corners as a doctor mom. 

Cutting corners is liberating

I’m all for it. First, I could hear the liberation in her voice. Her voicemail made me smile wide, as I rounded the corner on a walk with my little guy. How is this a good thing? Clearly, this is a lady with healthy boundaries in place- she just realized she could relax them every now and then. Hitting a fast food joint wasn’t something she planned to do on a nightly or even weekly basis. But when she hit the local mom-and-pop burger joint, it was novel enough for her and her kids, that they really enjoyed it. And she was taking a shortcut on feeding them dinner at the same time. That’s a win in my book. And sometimes, that’s what parenting is about. We are supposed to enjoy it! It doesn’t need to be an uphill slog, where you choose the “most correct” option every time, at your own expense. That’s my take, anyway. 

That’s why I advocate for strategic short-cutting. If I didn’t, I definitely wouldn’t have the time to write these thoughts down or share them with you.

Busy parent confessional

I’ll admit: I’m the kind of parent that will grab a go- container of rice and chicken from the hospital cafeteria for my kid sometimes. I’ll “pre-chew” it with scissors and feed it to my 4-year-old. What he doesn’t want goes in the trash, and there are no dishes to clean. Done! Could I make something myself? Sure. But I love cutting corners. My boy still gets to eat a variety of great foods, and I don’t have to make them. For myself, the shortcut is a pre-made meal from a healthy delivery service. It usually consists of something with too many ingredients for me to buy or chop. It tends to be something my little guy wouldn’t usually eat, but occasionally, he samples. With these shortcuts, we are both taken care of. 

Relax into it, and you might enjoy cutting corners as a busy parent

You see, I could go home and cook two meals, a healthy-ish one for me, and a toddler meal for him– or I could restrict myself to something he *might* eat, and cook one. But honestly, that would be a chump move after a long day. I mean, if shopping for groceries, cooking, and cleaning really soothed my soul after a long day, I’d do that. Or if I was one of these mythological types of people like my friend Anna (a busy surgeon) who finds doing dishes to be relaxing, I’d totally do that. But I’m not. There are preschool blankets to wash, lunches to prep, and superheroes to play with. There’s Pink Panther on Youtube. Being a busy parent can feel like having an unending list of tasks, yet we also need to relax. 

So whenever I see a shortcut, I consider taking it. I don’t fold most of my kid’s clothes, and I don’t sort his sock drawer. Our babysitter might occasionally fold all his PJs. But it’s not something I’ll spend time on. That’s an intentional choice. I guess this is the other answer to the question I’ve commonly encountered, regarding how I “do it all.” Hint: I don’t.

Cutting corners as a busy parent and practice leader

I’m the Clinical Director of my practice, the newest of many hats I wear. I don’t seem to wear them, I seem to accumulate them. I’m on the Brand Experience Support Board for my national practice, in addition to being Chair of my radiology department at the local trauma center. Over the years, it has often made sense for me to take these roles since I’ve been around a while, and I know what I’m talking about. But it means less free time sometimes. And after the meetings and clinical work, do I want to cook two dinners? Nope. I know a lot of parents do this, and I’m not one of them! 

I know I might sound like an underachiever, but it’s really more about strategy and flexibility. Some mornings, I will wake up to make my kid oatmeal from scratch, and fry chicken sausage that we picked out together at the store. The reason I do one thing one day and a totally different thing another day? I’m not an underachieving parent, I’m a strategic one. When I don’t have extra time for the fluff, I cut corners, or skip it altogether. My kid is exquisitely well cared for, and at the same time, my approach will (I hope) teach him the art of flexibility. Sometimes we have time to bake, other times we grab what’s left in the freezer. Mom is not going to sacrifice her sleep, sanity, or self-care to appease others. But you’re not going to go hungry, either. 

Cutting corners as a busy parent in a way that fits your family’s needs

I admit I’m highly privileged and grateful to say my food-related anxiety as it relates to my kid is near zero. He is healthy and thriving. I realize that’s not the case for all parents. We have to cut corners in a way that makes sense for us individually and for our families, too. That may look different in another family in which kids’ needs are different since these can obviously vary. I just use food as an example of something I could go nuts over but choose not to. 

What do we prioritize? Driveway picnics. I’ll put our kiddie table and chairs in the driveway for a picnic when Wesley wants. We cherish these unique picnics because they mean time to eat together al fresco. It matters much less what’s actually on the table. It might be a smattering of snacks, like a handful of little cheese wheels, which I threw in my purse on the way out of work. Our having a whimsical moment outside is what really matters to us. It’s not someone else’s version of a perfect meal, but it’s ours.  

So what? What if you don’t take shortcuts? 

In my experience, taking shortcuts is about priorities. It’s a way to live according to your values. If my bandwidth is sapped by something I don’t value a ton, like meal prep and cleaning, I won’t have the energy to be the sweaty mom at the trampoline park, cackling with my kid over dodge ball. Because I cut corners where possible, I have the energy to chase him around the warehouse-sized trampoline park. I’m grateful for my energy level, but it’s largely a function of my choices– because often, I am willing to de-prioritize or even throw out the rest. 

Some other ways to make life easier as a busy parent

Running errands together. I’ve heard this is something some parents feel guilty over, but I think it’s educational. We go to the post office, and my child thumbs through the birthday cards, and marvels at the automatic doors. He takes in the life experience of running an errand, taking in the sights and sounds of the place, and interacting with the people there. When I need a new light fixture for my rental house, he’s there with me, blazing through the aisles. I teach him about the need to stay where I can see him, and to avoid knocking others over with his enthusiasm. 

Taking my kid on errands is a shortcut for me, and it’s a learning experience for him. It’s teaching him about real life. It’s my version of perfect parenting. Why would I feel guilty about that? 

The cutting corners philosophy means eschewing a life in which I contort myself around my child’s comfort or entertainment, just so he can be slapped in the face by life later on. Don’t get me wrong, his is a highly privileged life. But I’m not going to make it worse by over-momming or momming myself to death. 

We need to take shortcuts. Do you agree? 

Here are some of my favorite short-cuts I’ve enjoyed: 

Thistle meal delivery – $100 bucks off your first month when you use this referral link.

Getting a deep clean of the house every month or whenever I get around to scheduling it. I rarely scrub toilets anymore, because then I’d be cleaning mirrors and floors and all the other stuff that comes with it. I used to get a lot of pushback on this (from the other adult in the house, who thought we should do everything ourselves), but for people who employ short-cuts in order to enjoy life more, this is a great one. 

Stockpiling hostess gifts for the next time someone invites me over, like a Primally Pure candle. Click here for $10 off. I’ve gifted this brand to discerning hosts with rave reviews. I love all their skincare too. 

My shortcut to relaxation: audiobook on the Libby app (free listens or reads from the library without the fear of losing a book in the house!) I love to listen on my commute.

Insight timer meditation app

This is my shortcut to put myself to sleep when my mind is a bit too active. It’s accessible for free and a fantastic shortcut to relaxation as well!

Kid-related shortcuts

Trips to the library. This is easy entertainment, and your tax dollars are paying for it anyway. I can take 30 books out at a time at my local library! Returning them all is another challenge… time to go look behind the furniture for those missing books. Still, it’s worth it! This is an easy shortcut for a parent who wants to feel good about entertaining his or her kids. 

Having a stack of kid birthday cards around to grab at the last minute. Who needs extra little tasks to remember every time a birthday comes up?

Hand me downs. Having a friend who can give you hand-me-downs means almost never shopping for a growing kid. It’s made any clothes shopping I do purely supplemental. Hand me downs are an amazing way to cut corners in parenting! Similarly, toy exchanges work well too. Basically, one man’s trash is another man’s treasure, and what’s old is new again. Just because you make money as a busy doctor doesn’t mean you and your friends should flush it on the kids. Save it for a spa day or a worry-free retirement, both great gifts for your family, who benefits indirectly 😉

In short, take a shortcut. Cutting corners as a busy parent sometimes gets a bad rap, but I’ve learned to embrace it as a powerful strategy to get shit done so I can go back to enjoying my life. I hope you enjoy trying it yourself, and also, you’re welcome.  

Do you want to squeeze all you can out of life? I do. That’s why my motto is “save lives, enjoy your own.” As a physician, I spend a lot of time serving, and I want to live well too. To me, that’s the balance. I want to live with purpose, to contribute to something greater than myself. At the same time, I’m not living for others, and I want to experience all the best life has to offer. That’s why when I heard of the idea of writing down 50 aspirations during a leadership seminar, I absolutely loved it. What better way to brainstorm all your biggest dreams? Writing them down makes them one step closer to becoming a reality. So here’s my list, and I dare you to create one of your own. Don’t hold back as you come up with 50 aspirations for your life! 

The prompt: what does it mean to have 50 aspirations?

If money were no object, and if you were to eliminate limitations of any kind, what 50 things you would like to do, try, accomplish, or experience in your life?

Experience

Live in Spain

Visit Italy and eat everything

Stay in a magical Italian villa

See Argentina

Soak in Japan, culture shock and all

Take a camper van around New Zealand

Have another baby

See the Galapagos islands

Spend a month on a houseboat in Seattle

See Alaska: the mountains of ice, the wildlife, what the cities are like 

Snowboard with my son

Snowboard at Whistler

Experience the Kayakapi Premium Caves in Turkey

Swim with whale sharks

Lope around the West including Glacier NP in an RV or van

Accomplish

Publish a memoir

Speak to over 500 people on a stage

Become a multimillionaire

Get 10,000 pageviews a month on my website

Inspire 1000 women surgeons

Get paid $5k to speak 

Get paid $10k to speak

Write a children’s book about women in male-dominated fields of medicine

Acquire a new income property every couple of years to create a nice portfolio

Own valuable land or a mountain as a potential future homestead or to flip

Indulge

Get a teak cabin in the jungle in Thailand with a personal chef to feed my fam

Rent a big ski cabin with friends

Rent a lake house in Idaho or WA

Enjoy a trip to Hawaii again

Be comfortable in my skin

Become more and more myself

Fly first class

Have someone buy me a first-class ticket to speak or contribute

Laugh every day

Curate a fantastic loungewear wardrobe

Try a personal stylist

Value & treat myself like a pampered pet

Health aspirations

Eschew sugar

Get help optimizing my diet

Maintain my skin/ age well

Maintain a steady weight

Experience every kind of love 

Master the art of setting boundaries

Spend as much time on a catamaran as I damn well please

Trust myself implicitly

Develop my intuition and connection with myself through reading, learning, & exploring

Even as you assemble 50 aspirations, recognize how great your life is now.

As I sit in my hot tub typing this on a sunny California afternoon, I’m already living the dream. Even as I go through a massive personal transition, my life is perfect in so many ways. I recently engaged a life coach to help ease the transition. She’d challenge me, asking, “What is perfect about your life right now?” I love this question because it turns on all kinds of light bulbs for me! Try it out for yourself.

1. My job is secure
2. I have options
3. My friends are beautiful, interesting, and big hearted
4. Life is full of joy
5. I ran today (and I’m grateful that I’m able to run…)
6. I live by these incredible mountains
7. There are Japanese orchids blooming in the trees
8. My family cares about me
9. My little boy is healthy
10. I have free time
11. I can create
12. There’s more to explore

I think you get the idea. 

I hope this inspires you to get out a pen and paper yourself– or at least the notes app on your phone!

I’m sending encouragement your way. As you march through life in a male-dominated field, don’t forget to dream. 

Want to thrive in a male-dominated field? Jump on my mailing list for blog updates and periodic inspiration from a fellow tired superheroine (that’s me).

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/ !