See you in a few weeks!
I'll be taking a little time off as my family transitions into a busy summer. There are new experiences for all of us, right around the corner. I look forward to enjoying even the seemingly mundane, which summer and newness make seem glorious.
See you in a few weeks!
A good friend of mine shared some news this week about a colleague of hers switching career paths of sorts. In the academic setting where she worked, this colleague was successful by standard measures: she had publications, had secured grant money for the institution for her research, and was respected by her peers. But she was leaving research academics for a job in administration instead.
A recent edition of Endocrine News that came to my mailbox talked about a crisis in Endocrinology, where fewer trainees are entering my field of specialization.Plus, of those who did enter the field within the last several years, many are leaving the traditional academic or small private practices and moving to different versions like large multi-specialty groups, or entirely new ways to use those years of medical education such as medical-legal opinions or marketing.
During my last year of medical school we had a guest speaker visit to discuss contracts. I recall this person telling us that a large percentage of us would leave our first job within 2 years. WHAT? Some estimates put it at 65% of doctors leaving their first job within 5 years. All of us sitting there could only think one thing: after all THIS, there is a high chance we would walk away from our first paying job, you must be kidding!!!??? Ah, the innocence of the unknowing.We had no idea what was ahead in our professional lives. Since graduation, I would wager that indeed the vast majority of my classmates who signed job contracts at some point have indeed moved on from those initial jobs to others, sometimes several times, even outside of advanced training purposes. The reasons are many. Forbes magazine had a sad but interesting article discussing discontent among physicians and the myriad of some contributing reasons.
In my medical school class we had several "non-traditional students" including lawyers and pharmacy doctorates who left their previously chosen fields after years of study and practice to instead pursue medicine, starting from scratch like everyone else. A search for "academics leaving academia" will yield more results than you can imagine, including a first page full of articles and blogs written by individuals doing just that. Interested in more resources? There are tons of books also talking about leaving the ivory tower, life after academics or life after PhD.
In "the old days" it was well accepted as the norm that you took on a career path(finance, government job, teaching,medicine,law etc) and stuck with it the rest of your life. These days it does not seem necessarily the case anymore, and for careers that take an initial investment of many years of study it can be jarring to witness someone make the leap from one career path to another. What is going on here? Are we now within a generation that has such different expectations of jobs and life that the old plan of finding a career you "stuck with" is no longer the norm? And if so, is that good, bad or just different? I remember thinking in medical school how incredible it was that someone would go through law school and all the way into practice only to change her mind and come back to another intense post graduate path of study.I didn't understand it at all really, not back then. But now I do, as do many of my friends and colleagues in medicine and other career paths.
I have found this is a topic that can be quite polarizing--the early professional career crisis and where it leads, or should lead. For some people the fact is simple: after you incur that much debt of time, effort, emotional and mental investment as well as financial debt, you stick this out and find a way to make it work for you. For some others, life is simply too short and filled with other important aspects to devote a large percentage of daily time( and years upon years of a lifetime) to a job you don't enjoy.
Nope, I can't tie up this blog simply and neatly. I don't have an answer and even if I claimed to, it obviously would not be right for everyone as all circumstances are so different. I think a big career leap should not be taken lightly, but I don't think many adults would take it lightly anyway. I do think being happy with your chosen career path/job is important as we can spend the majority of our waking lives at work. But I also accept that there is no perfect job, and that there will be days with bumps in the road or snags in the carpet that make some periods of time at work less than ideal.Or outright miserable. If those periods are relatively contained and brief, then you stick it out.If not, consider moving on. But again, this is my point of view, and unlike much of Endocrinology I have no numbers to specify when I would even make those decisions myself(what? An Endo not using numbers to explain something? Unheard of!). Leave after 2 years? 3 years? 6 months? I don't know.
What I have come to appreciate is that the early career crisis can be a good thing.It does not make you "flaky" or "indecisive" as some may think. Wanting to be happy at work is not entitlement, it is a reasonable goal for all of us. While I make some of those tough decisions myself, I have learned to keep an open mind and open eyes during these years of our productive working life. That career path chosen years ago may take some turns you don't expect and off-roading(temporary or permanent) may be more fun that you thought.
This week among the usual nonsense news about celebrities starting fights(who cares, really?) and serious pieces about wildfires in California was a major upheaval in the journalism world when Jill Abramson was removed from her position as Executive Editor of the New York Times.
Not surprisingly, given this being such a high level position, it drew lots of attention.And again not surprisingly, questions have been raised about whether or not this has anything to do with Abramson being a woman, and how her tenure as Executive Editor, leadership style and even her dismissal may have been interpreted/misinterpreted in light of her gender.
I will never say that giving consideration to the possibility that her being a woman unfairly set Abramson up for different judgement than her male counterparts because we all know that possibility exists, everyday, for women everywhere. What I will say is this: let's not jump to that as the first thing.
It is a difficult balance to take into account known issues surrounding discrimination of any type(which can be quite subtle) and not making them the centerpiece of an honest assessment of a situation. Further complicating matters is the simple fact that there is no one "truth". There are versions of truth as seen through the eyes of all involved, and then further changed in the way they are communicated to others, who can in turn alter the perception of said truths. For instance decisions can be seen as either daring/forward thinking or foolhardy/risky depending on how they are communicated and who is listening to the information being shared.
Like many people, I will stay tuned to find out what is discovered about the circumstances of Abramson's dismissal. I would like to know why the decision was made and in such a seemingly hasty fashion. But unlike some, I am not going to first assume this has to do with her being a woman.Instead I will first assume it had to do with the actual job done. Maybe I am wrong, totally wrong. But for me, I don't first assume an issue/failure/misinterpretation has to do with something I can't control. Instead I think it IS something I have control over and can change, so I set out to do so. If all my efforts fail or somehow don't turn out the way I suspect, then I look at those issues outside my control.
Despite what some may say, most women I know WANT it all to be about the work.They don't want their gender being an issue at all, negatively or positively affecting the way their work is viewed. It's fine saying, "the first female executive editor" and marking that with an acknowledgement, but then let's move on and make it about the work, please. We want neither excessive accolades neither excuses being attributed to our gender.
There has to be a balance between scapegoating our gender and ignoring the fact that societal biases exist. The day we find that balance and truly make it about the work will be a great one indeed.
How does a mother feel the night before she sends her 8 year old daughter to be married?
Married to a 40 year old man?
This question had plagued me after seeing the news article about an 8 year old Yemeni girl who died on her “wedding night”. The headline alone shook me so horribly that it took days for me to read the actual article. Even while accepting that I have read only one version of this story, and as an adult knowing that behind the reported news is often a more complicated version of the truth, I am still sure that the bare bones of this news story is exactly what it sounds like: a child being given to serve as a wife, in all its roles including sexual, to a grown man 5 times her age. Initially, like many of you perhaps, my mind was riddled with the horrific idea of this poor child, being taken into this disgusting “relationship” ( a word that hugely misrepresents this situation). At some point my thoughts took a shift from this 8 year old who died of internal bleeding, suffering a death most of us should never ever have to face as a possibility. My thoughts turned to her mother and I did not know how to feel about her, or for her.
When I became a mother myself, and by that I mean within the first months of pregnancy, something changed for me in regard to priorities. When my children were born, the biggest shift in my life occurred, and yes it sounds like a cliche but my life was truly changed forever. Even with all its stressful days and nights, fatigue and vexation, being a parent is a gift I would not ever refuse. My husband recalls me struggling out of my wheelchair after my c-section that came after 12 hours of labor, still sick from a fever during delivery, struggling to see my children in their bassinet, and weeping, and weeping. I cannot describe entirely what I was feeling, but from that moment my number one priority in life has been to keep them safe, and happy. I do this without thinking, and 100% willingly.
Did this mother of the 8 year old Yemeni girl feel that same way? I of course assumed that she did and this article is not about a mother not loving her children, far from it. I do not think the vast majority of child marriage situations stem from lack of parental love for the child. What I have struggled with is understanding, and accepting, that different cultures will influence a mother’s instinctual protection of her child, even to the point of willingly sending her to this horrible situation of child marriage.
How does it feel for a mother sending her child off to a situation in which you know she is almost assured of suffering? I can only imagine how heart wrenching it would be and hope never to know a situation even close. Even if this child did not die on her “wedding night” (a term so grotesquely inappropriate here that I cannot repeat it again), any person with even rudimentary knowledge of what typically happens between husband and wives would know this child would be suffering. They would know that if she survived the several years of what was essentially child sexual abuse, she would eventually become pregnant too early and have a high chance of dying in childbirth or experiencing complications of childbirth. And these say nothing about the other aspects of her life, her obviously low standing in society and in her marriage situation into which she had been given or traded.
But these are words coming from me, a woman born and raised in the western world, one whose mother infused in her the sense of you-can-do-anything from the day she was born. I am a physician and a wife, respected at work and in a marriage where I am seen and appreciated as an equal. I expected nothing less growing up and sought out both of those situations with purpose. Largely I count my mother’s influence as the driving force, and perhaps some inherent stubbornness of personality on my part.
What if my mother was instead this Yemeni mother, who would be expected to yield to the decisions made by her husband and village/town, no matter the outcome for her children? What if my mother was made to know that she had no choice, no power, and that her daughters had to serve larger roles in terms of satisfying family debts or honor?
Questions only lead to more questions.
How much does your own personality play a role? Would I as a Yemeni woman send my daughter off to be married at 8, to a 40 year old man? I would like to say no, that no culture or threat could make me send my child off to a life of pain. But that is my westernized and independent mind talking. If I was taught I had no power, and my decision was worthless, would I somehow speak out anyway? How much does culture and ingrained societal status of being at the bottom of the rung match up against individual questioning/stubbornness/resistance? Did this Yemeni woman ever think, “this is wrong and I won’t send my daughter?” Did she even think there was a choice? Maybe she cried the night before as she explained to her daughter what would happen the next day, and dressed her hair and kissed her goodnight, hoping maybe her daughter’s husband-to-be would be kind, and thoughtful and not touch this child until she was much, much older. Maybe the mother made herself believe in a miracle that frequently does not come to fruition in male dominated societies.
I need to believe that she did atleast consider fighting back. There are women all around the world who break that mold of subservience, and this is one big way to bring about cultural changes. Women and men refuse to accept the current state of things, question it, challenge it and sometimes suffer for their actions. Slave women have chosen death for themselves and their children rather than continue a line of slavery and suffering, a choice that can be seen as either heroic or cowardly depending on your point of view. Women have fled genital mutilation and arranged marriages, they have learned to drive, they have gone to school, they have run for office and spoken out in marriages, small groups and large meetings. They have been shot at, beaten, abused, imprisoned and some killed. Where one falls, another one rises, sometimes immediately and sometimes years later.
Big changes start on relatively smaller scales, like my mother as a teen refusing to continue the rules of her father’s house that women not wear pants. Her mother, my grandmother also rebelled against her husband’s preferred family dress code, and the seed was planted.
Maybe those men who talk about women’s independence being a “disease” are right in a way: it is a genetic disease of the mind and of the soul that spreads, often from mother to daughter, like a gene amplified from generation to generation until one day we see the full expression of a female who stands up against something big. A husband. A village. A nation. A culture or a religion. A woman who says “no.”
Hopefully somewhere around the world, against all cultural expectations, a woman is whispering to her daughter that she will not be married off as a child, . She will instead get an education, and marriage, if and when it comes, will be at a later time. Her daughter will be thoughtful and nod in agreement. And the gene amplification begins.
Mothers' day is a few days off and the sentimental part of me wanted to write about being a mom, about how it changed my life for the better, how my mom became my hero as I grew up, and that my grandmother and many aunts of mine are the strongest women I have known. I wanted to write that sweet kind of piece, but my mind and heart today are on mothers everywhere, and thoughts of how difficult it is to be a mother in many parts of the world.
The news has been burning up with the recent release of the video showing African militants Boko Haram claiming responsibility for the kidnap of over 200 girls a few weeks ago.More news has emerged about this group, as well as the even sadder fact that kidnapping has occurred in the past but only now has it garnered such attention because of the size of the group of girls kidnapped at once. It is this latter part of the news that makes me saddest and angriest: this is not new or novel, this happens often and not only in Africa.
Women and children have long been used as targets of war, and I don't mean only full out military wars but also cultural wars with varying levels of actual fighting involved. While making up the larger proportion of our world population that is the poorest, women and children are used simultaneously as targets, currency and disposables.
And so heading into this weekend where we celebrate motherhood, with its joys and challenges, I urge you to not only honor your mothers and those who have served that role in your life, and to inhale the heady sweetness of a day when perhaps you will be honored by those you love, but to also lend thought to mothers in situations most likely more dire than yours.
The refugee mothers
The mothers of those kidnapped girls, in Africa and around the world.
Mothers working against old cultural norms and helping to raise young women like Malala Yousafzai, who champion women's rights while risking their lives.
Mothers who know from the day their daughter is born that she will likely become a child bride one day, perpetuating an ongoing cycle of under-education, poverty and bias towards the female gender.
Women becoming mothers in countries where the risk of dying in childbirth can be as high as 1 in 18.
Let us honor mothers everywhere in some way, through thoughts, prayers, donations to local and world organizations, learning/educating ourselves, and yes, by speaking out.
See this guy to our left, with the disproportionate forearm muscles(or as he pronounced it, "mus-kels")? I credit him with getting me at age 9 to try spinach. Otherwise spinach was the yucky slimy green thing my parents plopped at the side of the plate at dinner.But when Popeye showed it, all fresh and leafy, it looked lovely AND then he turned super strong after eating it! Which kid could resist that kind of promise? Never mind that my parents still could not make the spinach taste great to me back then, at least I tried to eat it.I fondly remembered this old cartoon friend of mine today when I read about schools pushing back against the recent roll-out to change dietary practices in their cafeterias and on school premises overall.
This is not to start arguments about what government "should or should not be able to do." One of the schools' points is that the kids don't want the healthy options, so let's talk about our kids and food.
We all generally agree that many of the foods made available, especially cheaply and fast to all of us including our children, is not as healthy as it should be for a variety of reasons. You would have to live in an alternate universe to be able to deny that fact. The multitude of factors blamed for this include rising power of the food industry in lobbying and subsidies which lead to lower-cost foods that don't necessarily have more nutritional value, heavy marketing towards kids and parents, and decrease in time spent by families cooking their own meals. In this country child hunger is a real problem and also one of the contributing factors to less ideal dietary choices when it comes to nutrition. These are larger issues that affect us all, but in the end the choices do start at home, and outside of situations where food is scarce and choices therefore very limited, there is still often some room for atleast not-as-bad choices even if the ideal ones are not options.
As I have admitted in a prior post, I hardly claim to have a perfect approach to healthy eating.But I put in a good deal of effort towards this goal, and as a parent one of my main concerns every day is what my kids eat. Sometimes I feel like I am fighting for my kids' nutritional welfare. A walk through the grocery store is a minefield for me.There are some days I purposely avoid the cereal and cracker/cookie aisle because I simply don't have the energy to repeat the word "no" as many times as I sometimes need to in response to my kids asking for all sorts of yummy-appearing cereals and snacks. The trick of course is teaching our kids to choose healthy, or healthier options, when we are NOT around.Because when the cat's away the mice will play, right?
Part of the key to this lies in something I learned at the Healthy Kitchens course I took a few years back, where they said that healthy food needed to be "cravable", because otherwise folks would tend not to choose them over non-healthy options. Spinach that looked and tasted like yucky green slime would never win my kids over, but slightly wilted spinach sauteed with garlic just might, and spinach salad with pears certainly would(and has).
I am still working on the magic formula on my end. I find myself pushing a boulder uphill some days, like when I pack a healthy lunch but my kids come home laden with candy from school, some given as "rewards" for good behavior or success in a subject--why oh why can't something besides sweets be given????? But it is getting better. Here are a few approaches I have been trying:
First, teach moderation: I found a moment of parental pride when another parent pulled me aside at a birthday party and said, "I was inside dishing out the cake and your kids just turned down ice cream on top of their cake, they said the cake alone was enough.How did you do that?" Indeed I wasn't sure of the date or time but somewhere along the line I had communicated to my kids that there was such a thing as enough and another such as excess. And they got it.
Second, remove the cache of the illicit foods: A friend of mine alerted me to this issue years ago. She said, "We are going about this all wrong, making it look like a special thing to be given sweets! It should be an everyday thing so the kids don't attach special status to them and want them more." When I thought about it, that's exactly what I had been doing, saying stuff like, "we have cake on special occasions." I instead started treating them as ordinary foods and explaining they didn't work as well for making our bodies strong, so we should have less of them to make room for the foods that DID make us stronger and healthy. In the face of brownies or ice cream this argument is not always welcomed but we all know it is true.
Third, make those healthier foods cravable. Heck yes, kale can taste amazing!!!! As can eggplant and okra, which I actually don't even like myself. We try to find recipes and ways of preparing healthy food options that will make us WANT to eat them, and if we start with small amounts that is fine.Baby steps do count.
Fourth, I aim for healthy each time but cut myself some slack. Are waffles the absolute healthiest breakfast I could make? Probably not, but I pile them with fresh fruit and use only small amounts of syrup. Imperfect but not bad, and a lot better than a pop tart.Sandwich made with Hawaiian sweet rolls: ideal? Maybe not but, accompanied by lean ham or cheese and again those fresh fruits or veggies, it is a good option for an easy-to-pack school lunch.
And last, yes I put my foot down on some things. After explaining it every way I can, my kids sometimes do still launch the all out attack in the cereal aisle for Lucky Charms(which are never entering my cupboard outside of a foot shortage and there being no other options). I simply say, "No."
As a parent being the gatekeeper is my job too, and my responsibility. Given that I co-hold the purse strings with my husband, we both decide what enters the kitchen, not our kids. I can bear with some sulking on their part.
Is my approach perfect? No, by any definition you can think of, it is not. And yes we eat some typical "junk food" like pizza and hamburgers, but not often. My hope is that in the end my kids enjoy healthier options so that they prefer and choose those automatically over the less healthy versions. This may be part of issue with supposed student push-back the schools are talking about, claiming that the kids WANT those less healthy versions. Maybe those kids don't realise halthier food can taste fantastic. So let's start at home showing them how and explaining why those healthy versions are better. Because one day they will walk the cereal aisle without us, and put their own money where their health goes.
Okay, for those of you who know me this will come as no surprise but for those of you who don't, here is my confession: I am in love with breakfast.
For all those arguments about not being able to feel love for an inanimate object or a concept, I say "pah!" to you because I LOOOVE breakfast. How much do I love it? Enough to at least partly plan my vacation trips around the ease of getting a good breakfast, be it made myself or ordered in a restaurant or hotel. Enough to make me the one medicine resident who ensured her team had breakfast before rounding the night after call. Enough to get me out of bed and often forsake the chance to sleep in, just to enjoy breakfast quietly. You get the idea...I truly think it is the best meal of the day and it's clearly my favorite.
I am always amazed when I meet anyone who tells me they are "not breakfast people." How could you NOT be? This is the foot you launch from in the morning before your day really gets going.Plus, are you truly not hungry after a night's fast? Of course I do understand each person has his/her own preferences and habits. But if you come to visit me, expect breakfast to be served and you are free to partake, or not.
My patients often ask about meal strategies and content. I am not a nutritionist but thankfully have expanded my knowledge over the years since completing training so that I can at least offer some simple suggestions. For specific concerns, for example gluten free or lactose free meals, I defer to a trained nutritionist who has far better and more complex knowledge base from which to draw recommendations. My family does not follow a particular type of diet, neither do we have major restrictions such as gluten free diets. Over time, with accumulation of knowledge (and some better cooking skills), we have changed to a healthier and more balanced diet in general, but I would hardly hold us up as poster family of ALL THINGS PERFECTLY HEALTHY. Nope, afraid we can't earn that crown, but I think we do pretty well.
Using breakfast as my template meal, here are a few simple tips we use to try to keep things healthy while enjoying a meal that we all look forward to (yes, my kids are fully indoctrinated into breakfast-love):
1)Watch your portion sizes. My sister jokes that we are the only family in America that follows portion sizes, and to be honest we sometimes feel as though we underfeed our guests. It is now an ingrained habit for me to read the ingredient labels of our food,including even things like butter, milk and cream cheese being used to make something else. The quickest useful info off that food label is the portion size and calorie content.
2)No plate is complete without fruits or vegetables. And no, not the random sad lone strawberry sitting on top of four thousand pancakes covered in syrup.I mean filling the plate atleast half full if possible with fruits/veggies, then the rest of the dish comes on board. Not sure how much to aim for overall? The CDC has a calculator you can use to find out your recommended daily amount of fruits and vegetables.This not only ensures you get closer to the goal of several servings of fruits/veggies per day, but it helps with number 1 above, portion control of the rest of the plate.If you fill up on fresh fruits you will be less likely to eat a second helping of pancakes/sausage/bread.
3) Drink water.This I know will be a controversial one for many of you, but I would rather have whole fruit than fruit juice unless it is a very special freshly made juice, like passion fruit. Orange juice? Nah, I'll skip it and save my calories for my cappuccino instead. Drinks are notoriously deceptive in terms of caloric load,and we rarely follow portion sizes on them, so IF you are watching calories, consider skipping a juice and having water instead.
4)Watch those calories. I do not watch calories for my kids, but instead just ensure their meals are overall healthier than not. But my husband and I do roughly keep an eye on calorie load--not religious counting(although I did during pregnancy to ensure I was getting enough and not too much) but a rough estimate by label reading and watching portion sizes. Remember calories are present in healthy foods too, so over eating those may not be the best if that is a concern. I love avocados, but eating three of them at once in addition to the rest of my meal is probably not wise given how calorie dense they are themselves. It is a myth that you cannot become overweight while eating healthy meals.
5)When you can, cook your own meals. I am a bit of a control fanatic, it's true. But I also love ordering food in restaurants or having a treat of breakfast made by someone else in general. Which person doesn't, after making meals all week, right? The downside is that I would have no idea what went into those meals made for me, because I didn't make the bagel, or those pancakes, the frittata or the scramble. When I make my meals I know how much butter (if any) I used, if the buttermilk was full or low fat, and how much sugar was added. And I don't use token fruits on top, I LOAD IT UP. So even though I am not a nutritionist and cannot fully identify all nutrient components to a tee, when I prepare a meal myself I have a good idea of what is in it. Nothing against eating out, I love it and will continue to do it. But I feel strongly that in order to really control your diet and your health associated with it, you need to be involved in the cooking of your own meals.
Are you a breakfast eater? How do you enjoy it best, quick and efficient or luxuriously relaxed?