Wayfaring MD

Mercury is in retrograde!!

Evidence level: C

Oof, do I!

Ok here we go:

1. Consider surrogacy or adoption if marriage/longterm relationship is optional for you. Or sperm/egg donor situations. A friend of mine had a baby by sperm donor and surrogate right after graduating residency and I think that was a great option for her. I went the adoption route because I didn’t have the need to have my own genes duplicated and I didn’t feel a strong draw to physically carry my own children.

2.Cultivate your village now. Parenting single is hard. You need an abundance of time, money, or help to do it, preferably 2-3/3. Having kids will help you find out who your real friends are. The ones who told me they’d love to help me as a foster parent quickly disappeared when I asked for actual help. You need 3-4 babysitter options on hand at all times, and as a physician you need sitters who will work long/odd hours. I have been fortunate to find two who are willing to come stay with my kids at midnight if I get called in for a delivery. Living in the same town as family is ideal, but I live 6 hours from mine so I had to build the village on my own. Also consider getting a teenager or college student “mother’s helper” in the evenings. I had one briefly and she bathed the kids while I did dishes or laundry and it made bedtime routines smoother.

3. Don’t try single parenting while still in residency. People do it, sure, but it’s not ideal. If you can stand waiting a few more years, do. Residency schedules are wild and daycares typically aren’t open all the hours you’ll need help.

4. Think hard about your specialty choice. Surgical specialties are going to make single parenting considerably more difficult. It’s pretty hard to make it to a 7am case if daycare doesn’t open until 7:30, and delivering babies at 3am is hard when your own baby is at home asleep. Specialties with busy call schedules will also make having a village of sitters necessary. Consider an outpatient-only specialty or one with a lighter call schedule.

5. Similarly to #4, think through your work hours. Maybe working 0.6 or 0.8 is more conducive to single parenting. I work 1.0 but I have 2 admin half-days a week that I often utilize for my kids’ doctors and therapy appointments. The little things add up. When will you get your oil changed and your hair cut? Will you be able to take kiddo with you grocery shopping and to your own appointments?

6. Find a family-friendly work environment. My first two jobs were not conducive with single parenting for a variety of reasons (location too far from daycare, no flexibility of schedule, overwork, too many work expectations outside of work hours). I’ve been lucky to work in an academic setting in a residency program that is VERY family oriented, so there have always been people available to jump in and take over for me when I had to get a sick kid from daycare or when my youngest was hospitalized for a week. Will your job allow you time and space to breast feed if you choose to? Will they balk when you have to take a day off to care for a kid with the flu? Do they offer parental leave for adoptions? All stuff to think about.

7. Make a will. Have your end of life planning set. I’m sure you’re probably young, but when you have dependents this is something that really has to be done. Who will take the child(ren) if you are incapacitated or die? My sister told me no after I assumed she would be an automatic yes. Set up trusts for your kids so they’ll be financially ok if something terrible happens to you.

8. Figure out how you’re going to take time for yourself. Single parents often go, go, go and don’t take time to refill their cups. Find a hobby, a gym, a church or civic group, or a book club that you can contribute to and benefit from on a weekly basis so you can have some grown up time. Play dates for the kids don’t count. This is something I still haven’t been good at doing but it’s so needed. Maybe it’s a weekly babysitter or mom’s morning out daycare appointment. Maybe, like me, you have a friend who volunteers to take the kids one Saturday a month so you can have quiet mom time. But definitely find time for that massage or nail appointment that makes you feel human again.

9. Work on your own emotional regulation. I’m preaching to myself and all people with children here. People who parent with partners often have the option to say “give me 20 minutes to chill” and the partner takes over for a bit. You will not have this option as a single parent, so make sure you have ways to regulate yourself in the moment when you’re really frustrated with your kid so you don’t end up saying or doing things you regret.

10. Consider the burden single parenting has on the children themselves. I felt like I could be independent and do the parenting thing on my own, but my boys talk all the time about wishing they had a dad. They point out single men in stores and ask if they could be their dad. They miss out on dad things at school. They wish they had someone to help them with sports. They just want a second parent. I didn’t really consider how my contented singleness could potentially be a burden on my children. It may not change your plans, but give it some thought.

In a country as rich as America, it’s absolutely ridiculous that we haven’t made healthcare a basic right of our people. We have universal public schooling and have all agreed it’s beneficial for the country to offer free education but we haven’t made the same connection with healthcare. Every other developed nation in the world has some form of socialized medicine. We are being selfish and cruel to not follow suit.

It would save our country billions of dollars in the long run to have universal healthcare access. When people have access to preventive care and primary care, they tend to live healthier, more productive lives. This means more people in the workforce, sick people being less sick when they’re admitted to the hospital, and lower infant, maternal, and childhood mortality.

Wayfaring, having already volunteered to be a patient:

Dr. C, about to examine Wayfaring: ummm Dr. B, Dr. Wayfaring doesn’t so much like the face touching. You got another way to do this?

Wayfaring:

Unfortunately, I find a lot of forums online of dissatisfied people discouraging aspiring doctors because of the grueling nature of the schooling and how it sucks the joy out of you, yada yada yada.

This is disheartening to me on a personal level, because I have always struggled with my mental health. I am a survivor of homelessness and abuse during childhood, (I'm okay now, don't worry) and I am diagnosed MDD and C-PTSD because of this. My motivation and grades are tied very tightly to my mental health, and I usually exist at low energy levels. A regular day of high school uses up all I have, and I often slack off on homework, chores, and I don't study because I am so exhausted. (I usually get A's or B's on tests without studying, but it won't be like that in med school, I know. Comprehending the material isn't the problem.)

Is being a doctor achievable, for someone like me? It would be immensely rewarding, and very secure, but it's really hard to go about my day as I am now. College is going to be worse, med school will be an order of magnitude above that, and residency will have me playing the "how many hours of sleep can you lose" game. I'm terrified that if I try and go into this, I'll end up failing and in massive student loan debt because I burn out and lose steam while everyone else is still going. My parents think it'll be better if I do a trade school, but I'm sure I'll enjoy being an attending way more. I just don't know how to keep myself running well long enough to do it.

Thank you for reading, (and bearing with me as I overshare)

-Luca

Hi Luca! Wow I love your ambition and drive. In medical school there’s a story about eating 5 pancakes a day. Some days you have to eat 7 to make up for the days when you could only stomach 3, but each day you’re going to have pancakes. Focus on today’s pancakes and leave tomorrow’s pancakes for tomorrow. My advice for you is the same: focus on today’s pancakes.

You’re a long way from medical school yet. Focus now on learning how to actually study (even if you make good grades without studying) so that you don’t have a harder time when you get to college. Learn how to maintain your mental health now so that the depression doesn’t creep up on you later. If you learn these things now, the med school pancakes will be much easier to swallow.

Remember that shooting for med school doesn’t have to be an all or nothing shot. You don’t have to be married to the idea of medicine today as a sophomore in high school. Take things one step at a time. Pick a major in college that you can find a career with even if you don’t get into med school. If college becomes too much, take a year or two off and re-evaluate your goals. Just see how things go.

Nobody showed up.

This year I’ve:

- built and moved into a new house

- turned down the associate director job at my residency program. I’m not cut out to be the mean mama when residents are acting up.

- read 92 books, and yes, audiobooks count as reading.

- delivered some bebbies

- already required a drywall repair guy to come to the house because Wayward child #2 likes to throw things.

- researched Parkinson’s a lot. We think my mom has it.

- gone on a mission trip/taught a resident in South America

- left my boys with a sitter/friend for 9 whole days while I was in South America. Talk about nerve-wracking!

- learned to braid my boys’ hair

- watched at least 1000 episodes of Bluey

- bought, rode faithfully, and quit riding a Peloton

- given thanks for my flexible schedule a hundred times

- played a lot of board games and watched a lot of YouTube with my children

Patient: has chronic nausea. Strangely only happens with physical exertion, not related to mealtimes.

Wayfaring: *works up patient for GI things* welp, it’s not GERD, pancreatic insufficiency, H. Pylori, mesenteric artery insufficiency, colon cancer, etc.

Patient: so what is it?

Wayfaring: well your heart’s bad. I think this may be your personal symptom of angina. Every time you exert yourself you get nauseated. Let’s check out your heart.

Cardiology: well he has severe aortic stenosis but the nausea is unrelated

Wayfaring: I think it is.

Cardiology: it’s not. He’s not having symptoms from his severe AS.

Wayfaring: ok but he is. He feels like throwing up every time he walks more than 50 feet.

Cardiology: nope, not angina.

Wayfaring: except it is. How bout fix his aortic valve?

Cardiology: *waits 2 years* patient isn’t having severe enough symptoms from his severe AS.

Wayfaring: except the debilitating nausea

Cardiology: which is not anginal

Wayfaring: about that severe AS, can we maybe fix it now?

Cardiology: we’ll fix it now. *fixes it*

Patient: feels 100% better

Cardiology note: patient’s anginal symptoms of shortness of breath and nausea completely resolved status post TAVR.

Wayfaring:

Better to soil the finger than the reputation.

1. Good sense of humor

2. No sense of smell

3. Small fingers

1. Wash yo dirty hands before the fun and games begin.

2. Wash your toys with soap and water between uses and don’t share them. The dishwasher is an option.

3. Barrier protection still applies to prevent transmission of diseases genital <—> oral. Use dental dams or homemade ones (cut open condoms) or wear gloves.

4. Get your HPV vaccine.

5. Get consent before you start and maintain consent for the duration.

I’ve spent 8 years getting mentally well and reducing symptoms but I can’t help but still feel a bit out of my depth.

Medicine is a field that proudly declares how little sleep everyone functions on. I sleep 10 hours a night. That has me down to no cataplexy on a daily basis but if I stop getting 10hrs I become more “traditional” in narcoleptic presentation. It’s hard to not feel like I’ll be drowned by other premeds if they ever would find out.

It’s hard to envision surviving the rigorous standards with 10 hours of sleep plus an hour minimum of morning inertia. Of course I’m trying to reduce symptoms further but I don’t know if there are doctors who’ve survived schooling while managing narcolepsy. I don’t know if it’s really possible outside of the hypothetical “anyone can do anything they put their mind to” rah rah positivity.

I’ve never heard of anyone like me actually *doing* it.

Since it’s that time of year…