On Discovering It Was Twins…

As the ultrasound tech quickly scanned through I caught glimpse of two small bubbles and asked her to stop. “Is that two?” I asked, as she measured, snapped, and moved on. “The doctor will be in to talk to you in a second.”

We’d been trying for months and I could hardly grasp the two pink lines, much less the thought of this baby being babies.

… “No seriously, IS THAT TWO?”

She stopped scanning and looked at me with a ‘not-saying-yes-not-saying-no’ look and said “Everything looks fine. I’m going to get Dr. Yeomans now, just sit tight.”

I knew Dr. Yeomans, he was an incredible MFM physician who also happened to be my mentor. As a third year med student, I also knew a (tiny) bit about ultrasound. I looked at my husband – “I think there might be two. I think I saw two in there. YOU DID THIS! Did you see two? YOU PRAYED FOR THIS! Do you think it’s TWO? What if it’s three?! YOU THOUGHT TWINS WOULD BE COOL AND NOW IT’S HAPPENING – WHAT ARE WE GOING TO DO?! Oh my gosh what are we going to do? I’m going to have to drop out of medical school!”

If you’ve been following for more than half a minute you know it was, indeed, twins…and I did not, in fact, drop out of anything. I would leave that ultrasound appointment and give a collaborative presentation to 150 people for my Family Medicine rotation. Shaking, nauseated, and in a full-on cold sweat, I would get up in front of 150 people who thought I was a terrible public speaker and discuss hypertension, while silently (but not covertly) panicking about the state of affairs in my uterus.

Those two blips on the screen are now smart, sassy, beautiful 5yo girls. Someday I’ll tell them of the months it took me to go from terrified and overwhelmed to excited about the fact that there were two of them (and how I simultaneously could not imagine it any other way after that first moment). The incredible chaos they bring to our lives is exactly what we need every single day.

Finding out about their little brother was similarly shocking, but in a totally different way. Getting pregnant with the twins had been this whole ordeal involving infertility, doctors, ultrasounds, prayers, medicine, and third year rotations with ovulation prediction kits in hospital bathrooms. With Milo, however, it happened so fast that I was completely unprepared and, nearly embarrassingly, blindsided.

That positive test, however, was followed by a threatened miscarriage in the midst of a busy and mentally-challenging night float rotation. That was followed by un ultrasound with no heart beat and so little hope (from me) that he would actually stick that I just had my residency BFF scan me alone, because I so desperately did not want my husband to witness what I knew would break his heart.

As rain pattered on the clinic window, my co-resident and best friend turned the screen to me and laughed – “look, it’s fine. See right there – a little grain of rice with a heartbeat.” My tears swiftly joined the downpour outside, “I would’ve told a patient to stop stressing and wait for the second scan…I am never, ever saying that to someone again…”

In the next few days I’ll share the rest of this story and answer one of the most frequatly asked questions on MamaDoctorJoneswhat was it like having kids in medical school and residency?

Residency Work Hour Restrictions

The Grass Is Always Greener?
Growing Up in the Era of Work-Hour Restrictions

Tired DoctorIn 2008, the IOM study on resident work hours came out and in the years that followed the Accreditation Council for Graduate Medical Education (ACGME) subsequently implemented a gamut of “recommendations.” As a medical student, I remember thinking it was a much needed change – why wouldn’t it be a good idea to improve patient safety and decrease resident fatigue?

Alas, as a newly minted intern growing up in the era of work-hour regulations, it’s become apparent that many of these changes may actually make life harder without achieving their main goal of improving patient care.

The 80-hour work week cap is fine; it’s been in effect on its own since 2003 and overall it seems to have made residency more humane. Most programs have found reasonable ways to limit work hours to this full-time-times-two amount, at least when hours are averaged over four-week periods.

However, the additional bullet point “recommendations” from 2010 seem to play out very differently in real life than they do on paper. Many of them seem to be arbitrary lines drawn in political sands hiding behind a facade of patient safety, but that’s another blog for another time.

So, what do the bullet point regulations look like in the hospital?

They look like: Interns can’t work 24-hour shifts. 

So, what used to be a two-and-a-half shift weekend turns into a four shift weekend. At a four intern/year program like mine, that means instead of two people splitting the weekends and having a post-call day after 24 hours on, one intern is committed to night-float six nights/week for a month while the remaining three interns take the three leftover weekend shifts. The result: Fewer hours at a time in the hospital, but more working days in a row and more days/month away from your family.

Is that worse than working a 24-hour shift? I’m not sure it is. It’s certainly not better, though, and I’ve yet to see convincing data that it’s made drastic improvements in patient care; I have seen a few mildly convincing reports that it’s potentially done the opposite. What it has definitely done is make scheduling and coverage more stressful and taxing.

I tend to agree with this recent JAMA article suggesting limiting hours without changing workload is completely counterproductive. I do, however, consider myself incredibly lucky to be a resident at a humane program that takes care of its residents.

The regulations seem to be put into place without regard to specialty or program size, which could be the fundamental flaw. What works for primarily clinical specialties like Family Practice and Pediatrics may never work for primarily surgical specialties like General Surgery or for mixed surgical specialties like Ob/Gyn and Orthopedics. In politics and in medicine, blanket regulations, while easier to create, track and implement, rarely achieve proposed goals on a global level.

I guess it won’t matter for me too long – come July 1, 2014 I move up in the ranks to “2nd year” and am suddenly capable of working a 24-hour shift…yet another arbitrary line those bullet points draw in the proverbial sand.

What do work hour restrictions look like in your hospital?

 
I originally wrote this post for my monthly column over at The American Resident Project, a collaborative blog with some of the best resident and medical student bloggers that I some how got invited to participate in. Check it out here.
 
 

Image Credit: imagerymajestic | freedigitalphotos.net

Meet Our Au Pair – Childcare in Residency, Part 1

Mary PoppinsGoing to an ultrasound, peering at the inside of your own uterus broadcast on a screen, and seeing a little embryonic heart beating is equal parts exciting and terrifying. Seeing two little embryonic hearts beating, while still exciting (especially after infertility), is mostly terrifying.

After we got used to the idea of two babies, two cribs, two carseats, two NICU bills, two co-pays, and two adorable little girls we started approaching the issue of two daycare spots.

Conclusion: Babies are friggin’ expensive. Multiples are friggin’ expensive on steroids.

  • How much would it cost to have two infants in daycare full-time?
  • How often would we be having to take off work for double-doses of the sickies?
  • How much would we have to change our preferred ways of raising our two mini-humans because of protocol or rules?

A lot. To all of the above questions and countless others, the answer is a lot.

We knew there had to be options other than daycare, so we googled and asked around and ended up researching several options, including Au Pairs.

What Is An Au Pair?

Think foreign exchange student blended with Mary Poppins and all wrapped up in a tortilla of cultural exchange topped with awesome sauce. That’s an Au Pair.

So, a few months into parenthood we embarked on our journey to find an Au Pair using the only agency that serviced our area, Au Pair Care. An Au Pair is (typically) a young woman from a country other than your own who takes care of your children and things related to them. In addition to childcare, most Au Pairs take some sort of college courses & focus on better learning the language and culture of your country.

For Twin Tuesday I thought I’d do a series on Au Pairs and answer some of the common questions I get about having an AP. But, for today I’ll introduce you to our wonderful Au Pair, Odelia.

Welcome To Texas, Odelia!

(the newest, and likely most normal, member of the Jones family circus)

Our Au Pair

Odelia is from South Africa. She’s 19 years old and meshes so well with our family if it wasn’t for her weird accent I would swear she was born into it (the fact that she can not only take our teasing and sarcasm, but send it flying back only proves this point).

She is absolutely wonderful with our babies. When we were interviewing her we told her we were looking for a big sister for our girls, not an employee, and that is exactly what we got.

She grew up outside of Johannesburg in a small town, so moving to small-town Texas wasn’t too much of a change.

Just kidding. Total culture shock. We may not live in downtown San Francisco, but can you imagine leaving your family and the place you’ve been raised to literally go across the world and live in new country with the circus that is this family? I mean really, three crazy dogs, two tiny babies, a mom who works 80 hours/week, and a dad who might as well be the paparazzi with the way he follows people around with cameras…that is insanity, y’all.

Throw in Texas football, weather, language, and Mexican food and we’re downright lucky she didn’t flee on day one.

We’ve been blessed with a new family member and loving childcare provider all in one. It will be a sad day when we all say goodbye and give her back to her “real” family. Until then, though, I’ll spend my time thanking her for her hard work and trying to convince her to guest post for me at Mind On Medicine. Don’t we think that’d be awesome?

In the next Twin Tuesday Au Pair post I’ll answer questions about having an Au Pair – so if you have any burning questions let me know!

Breastfeeding Twins

2013-03-30 14.21.36We’re about to get real up in here and talk about something I think is so important to talk about publicly. So, if me talking about nursing my babies ain’t your thing feel free to exit now…otherwise, prepare yourself to get a tiny bit little personal.

(P.S. Mind On Medicine could be abbreviated to M.O.M. Can we all take a moment to relish how ridiculously fitting that is?)

I knew when I was pregnant that I wanted to give breastfeeding a good ole college try. I would give it a go, see how it went, and hope for the best. When I found out we were having twins I became even more okay with supplementing formula or completely formula feeding if nursing didn’t work out. My number one goal was happy babies and happy mommy, however that happened was fine. However, I did know I wanted to give it my best shot, since breastfeeding is the best thing for babies and has some awesome benefits for mom as well (lower rates of some cancers, weight management, lower risk of post-partum depression, etc.).

Somewhat out of character for me, I didn’t read a bunch of books or investigate a bunch of websites. I read up a little and went to Twitter for tips and tricks and hoped the lactation consultants (LC) in the hospital could guide me through the early days. What I didn’t expect was to be sick before and after delivery, to be recovering from a major abdominal surgery, or to have two slightly premature babies with immature lungs in the NICU on respiratory support. But, we rolled with the punches and moved forward.

After my c-section I was started on Magnesium for pre-eclampsia (my blood pressure was really high – 180/110 when they put me in the hospital – and I was losing protein in my urine) and had to stay in bed for monitoring, so I wasn’t allowed to go to the NICU and see my babies until they were over 12 hours old. All the Twitter peeps had told me to put the babies to the breast early and often so I could establish good feeding habits, but clearly that wasn’t an option for us. So, now what?

When the (amazing) L&D nurses finally wheeled me to the NICU the (equally amazing) neonatology team was rounding and asked if it was okay if we started feeding the babies. I can’t remember hardly anything about the first 24 hours after my surgery, Magnesium does weird things to your brain, but I do remember asking if we had any options other than formula. They told me we could use donor breast milk (um, freakin’ awesome that moms choose to donate their extra…THANK YOU) and we all agreed that our number one goal was getting some weight on these babies so I could take them home, so donor milk  it was.

At some point in that first day a LC came by and hooked me up to a breast pump. Holy weirdness, people. Those things are strange. She explained it to me and told me not to expect more than a few mL in the first days, especially with the babies away from me in NICU. She wanted me to pump every 2.5 hours around the clock for 20-30 minutes at a time in order to establish a good supply. Welcome to mommy-hood!

So, I diligently followed orders with the overwhelming love, support, and encouragement of my husband. I’m so thankful he was so helpful when I was sore, exhausted, and sad in those first few days.

They mixed what I pumped with the girls’ bottles of donated milk and 6 days later we were leaving the NICU…with no decent amount of milk in sight from me. I was sure I had a milk-dud situation on my hands.

The NICU gave us feeding guidelines and loaded us up with bottles of Neosure, so that when we got home they’d have something to eat.

Almost instantly as we got home my milk came in. Something about having the girls with me kicked my production into high gear and I was able to start pumping enough for them.

It was a rough road and I won’t discuss it all here, because it would be the longest post ever, but it involved  a month of exclusive pumping, a slow transition to nursing with a shield, a long process of weaning off shields, and finally mastering exclusive nursing in time for me to put away the pump a couple weeks before going back to work.

I’m now back at the hospital with 180+oz of milk in my freezer (oh, did I mention the massive oversupply once my milk finally came in?), pumping enough for them to eat while I’m away, and incredibly proud of my decision to breastfeed despite our obstacles.

Another thing I’ve gotten out of all of this – a very clear understanding of why exactly people choose not to nurse their babies. It’s freaking hard, people.

If you’re pregnant or have a new baby and have questions, shoot me an email. I’ve picked up some tips and tricks along the way and I feel like since I’ve made about 60 gallons of milk (yes, seriously) in the past 18 weeks I am somewhat of an emerging moo-cow extraordinaire.

Questions People Ask Twin Moms

From the moment you find out you’re having a baby people have questions – is it a boy or a girl, what are you naming it, how are you feeling? When they find out you’re having multiples, the questions increase exponentially by the number of babies gestating in your uterus. And, when those babies finally arrive and you take them out and about, people have even more questions!

As A Twin Mom, Always Be Prepared To Answer The Following Questions:

  • Are they twins?
    No, they’re triplets…oh my gosh, have you seen their brother?!
  • Are they identical?
    No.
  • They look the same. Are you sure they aren’t identical?
    Yes.
  • How do you know they aren’t identical?
    They have different blood types. And hair colors. And eye colors.
  • Are they “natural?”
    No, actually we made them from MSG and Red Dye #40 in our garage.
  • You had a c-section, right?
    Yes, because they tried their hardest to come out feet first…not because they are twins.
  • Are you getting any sleep?
    They’ve slept 10 hrs straight every night since the day we brought them home. Why? Do you think I look tired?
  • Are they your first?
    And second.
  • Will you have any more?
    I’m due in 8 months!
  • How do you tell them apart?
    I can’t really, each morning I just pick one to be Amelia and one to be Reese…surely it will balance out eventually.
  • Do twins run in your family? 
    They can’t even walk yet…but they’ll probably run some day.

In all honesty I don’t mind the questions – I’m so proud of these two that it makes me really happy other people are interested in them! Sometimes it does get old being able to predict every conversation I’ll have while I’m waiting in line at Baby Gap, but I’m so grateful to have healthy babies I could answer these simple questions all day long.

Speaking of Baby Gap, though – that place is the holy grail of adorable baby clothes. I wish I could get them to sponsor this blog – surely one of you has the connections to make that happen. MAKE THAT HAPPEN!

Any other twin moms out there get asked the same questions over and over? 

Medicine, Marriage, Family

I remember when I was considering applying to medical school being terrified that becoming a doctor meant I’d never be able to have a family. Every Google search led to horror stories about divorce, blogs berating physicians that chose to have children, and forums full of miserable doctors. I almost chose a different career path purely out of fear.

As I’ve mentioned before I strive to make this blog a balance of medicine and other things – particularly family. I want my blog to serve as a place for pre-meds and medical students with these worries to find a positive story.

I love blogging about medical training and education, but the goal of Mind On Medicine has always been to create a place to write what we might sit down and talk about over a cup of coffee…and I can guarantee right now there would be lots of talk about mothering multiples, being a working mom, breastfeeding twins, returning to work, sleeping in 2 hour chunks, etc.

So, in order to continue in my endeavor to have work-life balance on this blog, I’m going to be starting what we will oh-so-creatively refer to as “Twin Tuesday.” On Tuesdays I’ll share anecdotes about adorable babies (obviously), but I also hope to delve into some of the challenges and excitements of being a mother in medicine.

I hope if you stumbled on this blog and you’re worried about medicine and family life and marriage that you will stick around! It’s not easy, but it is possible…it’s an adventure that I’m so glad I have chosen to embark on. And, while I still have a ways to go, knowing what I know now I’d still choose to do it this way!

Also, if you’re considering throwing your dreams of medicine out the window because you think you have to choose one or the other, I hope you’ll email me first so we can chat. I’ve been in your shoes!

Anatomy Scan

21 weeks + 2 days

Today we had our “anatomy scan” where they basically do a detailed ultrasound of the baby to look for various fetal anomalies or malformations. We got great news – everything is looking perfectly on track for both Little Elves*! Basically each appears to have a three vessel umbilical cord (which mean two arteries and one vein per cord), two kidneys, a cute little round stomach, a four-chambered heart with good outflow tracts, no obvious brain or spine malformations, etc. We are so overwhelmingly happy and feel absolutely blessed!

Baby A Information

This is a picture of Baby A with left arm over left eye and hand on head. This little guy/girl wouldn’t cooperate long enough to let us get a really good face shot! I think this one is still adorable, but of course I’m a bit biased. 🙂

  • Heart Rate: 152
  • Approximate Weight: 14 ounces
  • Position: During the scan this little one went from vertex (head down) to transverse left (horizontal with head on my left) to breech (head up by my ribs) without me even being able to tell gymnastics were happening in my belly! It was the craziest thing.

Baby B Information

This is a picture of Baby B with one arm/hand up over the right side of the face and the other under the chin! This little one was slightly more cooperative with face shots, but still wouldn’t let us get a full-on picture.

  • Heart Rate: 155
  • Approximate Weight: 14 ounces
  • Position: Breech on my left (so curled up a bit with head near my left ribs).

 
 
 

*Since we don’t know the sex of either baby (and aren’t finding out until they can show us in person themselves) we are lovingly referring to them as “The Elves.” This name came about because they will hopefully be here around Christmas time…oh and also they looked a bit elfin in their early scan pics. 🙂