Medicine from the heart . . . Alisha Carson, SOM ‘12 
Each Thursday, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit: http://www.umassmed.edu/news/articles/2011/personal_stories.aspx.
Reflections from the medical student mom
While at home on my son’s sick day, I sit down to relax during his afternoon nap. I could be doing a number of things: studying for my upcoming family medicine exam, reading the pile of articles I printed on recent patient cases I wanted to learn more about, the three loads of laundry that are sitting upstairs, tidying up around the house, washing baby bottles, finishing my overdue yearbook page, keeping up with my email, finalizing my fourth-year schedule, updating my son’s baby book, or playing in the backyard with my slightly neglected dogs. Instead, I sit here in a quiet room while my baby sleeps reflecting on what it’s like to be a medical student and a mother.
Being a mother in medical school can be challenging, particularly when your child becomes ill. As a student, I’ve acquired enough knowledge to worry myself consistently about the health of my child and develop a differential diagnosis long enough to keep me examining him every five minutes in case something new pops up that I missed the first time. Having successfully finished my pediatrics rotation just last month, I’m fairly confident in my diagnostic skills and management plan for children and infants with viral illnesses, which my son has had many of this winter. That being said, when it comes to my own son, I’m constantly second guessing myself wondering if there’s something I missed. “Does he have pneumonia? Did he just pull on his ear? Has his work of breathing increased?” Unlike the clinic or hospital, I don’t have an attending or resident standing by to confirm my diagnosis and plan. Instead, I’m at home with my stethoscope constantly listening to his lungs with every cough, wondering if there’s something more I could be doing for him, or if I need to bring him in to the clinic so someone more experienced can examine him.
My most challenging experience as a mother thus far was two weeks ago. My son had fever, cough, horrible congestion, junky sounding lungs and increased work up breathing with some mild sub-costal retractions. It started over the weekend with the congestion and by Sunday night he had developed a fever. My poor little guy had these rosy red cheeks when he was feverish and didn’t want to do anything but cuddle. I would wake up multiple times throughout the night to check on him and his breathing. Additionally, he would wake me multiple times throughout the night because he wasn’t feeling well and needed some comforting. Luckily his dad has a flexible job and was able to take a few days off from work to stay home with him while he was sick. It was tough for me, particularly as a breastfeeding mother, because breastfeeding can be so soothing for a baby and I felt guilty for not being able to be there to help soothe him throughout the workday. Nonetheless, I faithfully went to work, but the first thing I did when arriving was use UpToDate to refresh myself with respiratory syncytial virus (RSV), which was top on my differential. I already knew the treatment was supportive care but was still hoping there was something I could do to help him feel better and breathe more comfortably. Despite having seen many children in clinic with a similar illness and having counseled the parents on the appropriate management plan and signs to watch out for, I repeatedly asked myself, “Do I bring him in to see his doctor, or am I confident enough in my own plan and that I haven’t missing anything?” I struggled all week with my decision not to take him in to see his doctor and was somewhat comforted by the fact that he had his six-month well child checkup scheduled the following Monday. By the next Monday, he was doing much better but was still not at 100 percent. After listening to his lungs, his pediatrician did indeed confirm my suspicion that we had just personally experienced bronchiolitis.
My own personal experiences as a mother have greatly influenced my interactions in the clinic with parents and child. I have a genuine understanding and empathy for parents’ concerns because I know where they are coming from. I find it easier to counsel them and answer many of their questions because I have experienced many of the same things with my own son. I’m confident with my advice for parents because I’ve spent quite a bit of time looking up the best evidence-based medical practices for children and infants for the questions I’ve already answered for myself. I also find myself taking the extra time and effort during sick visits to explain what the course of illness will be and when to worry and not to worry, as well as the important signs and symptoms to look out for because I know what it’s like to be at home worrying about your child. As a mother, I feel more emotionally tied to treating children and making sure they get the best care possible. Part of me is always thinking, “If this was my child, how would I manage the illness?” This connection keeps me highly motivated to provide my patients with the best medical care and also helps me bond with my patients on a more personal level.
At the end of the day, being a mother has many challenges, especially during medical school, but it is one of the most rewarding experiences one can have. Becoming a parent has not only helped me mature as a person but has also helped me grow as a future physician. Despite the new time constraints on my ability to study, being a mother has drastically improved my diagnostic skills and ability to counsel parents because not only am I a future doctor, I am also a worried parent!