The parenting series

Part one: It might not happen as quick as anticipated….

Photo by Dominika Roseclay on Pexels.com

This is a series I have been thinking of doing. Inspired by multitudes of my patients and addressing some issues that are related to the parenting journey in general… I am hoping that the upcoming little snippets of the journey to parenting, some very personal to me, shine a light on a topic that is rarely talked about in normal conversation. All those struggling with fertility or struggling with parenthood, just know that I see you and hope by normalising the conversation you can stop hiding your own struggles and feel open to talking to your GP.

Part 1: It might not happen as quick as anticipated…

It was a lovely weekday when Rebecca* and Sam* arrived for their appointment. They were a lovely young couple in their late twenties, and they had jumped through all the adulting milestones and were ready to be parents. Except, it was not happening which understandably was frustrating for them. They had got married, bought their house, got their large family car, and updated their health insurance for the upcoming stork delivery but it seemed the stork had the wrong address.

With the unrelenting questions of “when are you having babies?” from friends and family they had finally decided to come and see me for some assistance.

We started unpacking their presentation. They had already downloaded some apps to track her ovulation and they would have sex every day at the times when the app was saying and despite that, it was now 6 months later, and they were over the disappointment that came with the monthly period.

This was an easy one, or at least there was still room to move before we needed to refer them for specialist intervention.

First, we discussed that at their age they had 30% chance of falling pregnant with every cycle which is always interesting as most people tend to think the chances of conception are very high. Sure, if they were 16, they could have sneezed* and had an unplanned and unwanted pregnancy but usually when pregnancy is wanted, it does not always seem to follow the script as required.

Also, given their age and relative health, they were technically allowed to try for about 12 months in total before we started to investigate for medical issues that might be the cause of their difficulty in getting impregnated.

Additionally, although the ovulation apps let you know then the ovum/egg is released from the ovary, if you think of how small a sperm is and how far it must go to meet the sperm, it makes sense that if there is no sperm already at the end of the tube waiting for the egg to be released, you are already too late. Having said that, going at It like rabbits is not likely to help either as the amount of sperm in the semen is likely to reduce with time.

So as the consultation continued, I could sense their relief there were remedies we could trial before they were officially “sick”. First, they were to use the ovulation information they already knew but start the horizontal dance twice during the week and once on the weekend from about 5 days prior to ovulation until at least 5 days after the egg left the ovary. That would hopefully bring back the fun of doing the dance but also hopefully the reduced frequency will mean the concentration of sperm is maintained in the semen increasing the chances of getting knocked up. 

They left my consultation room looking more hopeful than when they arrived with some homework to consider. A few months later, Rebecca arrived with smiles beaming. She had peed on a stick and saw 2 lines…

*not real names or real patients

PS: remember that this blog entry does not constitute medical advice. If you have any questions of a medical nature, contact your nearest medical facility for help.

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Losika Writes at ABC Australia!!!

“A man’s gift makes room for him, And brings him before great men.” – Proverbs 18:16

Losika Writes has truly opened many a door for me and has brought me before great men, and women hehe. I have had the opportunity to go to ABC Australia Melbourne studios to not only talk about my passion project of ensuring that every African child growing up in the diaspora has books in their native language, but to also talk about important issues of motherhood and general practice. I am looking forward to where all this leads and hoping the universe guides me as I navigate what I truly believe is a calling.

Support our side hustle and know that when you do, you enable us to fulfil our why.

RACISM has no excuse!!!

Today I was accused of stealing a patient’s $100 bill at work. She claimed that I had fleeced her of her money last week and “unless there is someone else in this clinic who looks like me”, then it was obviously me who could have taken her money under false pretences. Now granted, we did have a consultation last week and I organised a surgical excision which would have had an out of pocket cost compared to her usual bulk billed consults. However as all of us should know, doctors never handle money as that is what reception is for, there is no way I would have processed payment for an anticipated procedure. Trying to highlight this flaw in her thinking just led to more venomous attacks of me and going on about how unless someone “like me”, and when asked to elaborate on what she meant, she reported “black people like me”, I could be the only person who took her money.

 

Not only was this hurtful as I had looked after this patient for a year now through challenging times with her family, it was sadly not the first time I have had racist insults hurled in my face by members of our community. I have been insulted in the presence of my then 3-year-old son, and informed that the reason we are brown is because we are the s*#t of the society whilst on a train home from a city outing.

 

Today however was different and to me sadder as I realised that people who have never experienced racism are quick to make excuses for racist behaviour. The trending ones for today was “she is old, she might have dementia” as if getting old and maybe having dementia have RACISM as a side effect. Excuses for the guy on the train was “maybe he was drunk, maybe he was high” again as if drugs and alcohol should have RACISM as a listed side effect. Now, racism is not a side effect of any of the above or any other reasons people might excuse. You are racist and for whatever reasons you might become disinhibited enough to actually spill your vile ideas.

 

When someone is being subjected to such, I would advise that if you are someone who has witnessed such behaviour- call it out for what it is, listen to the distress of the person who has been vilified and say, “I am sorry you have had to endure this today”. It is the equivalent of being quiet when breaking bad news etc when the less you speak actually speaks volumes. There is no need to try and pretend people were not trying to be racist when they are or worse excusing their behaviour.

 

I admit, I am guilty of not calling out such behaviour because I actually hate to bring up the so-called race card and I am really not confrontational. Today, the whole experience was surreal, as if someone was going to come out of the woodworks and say “smile, you are on candid camera” or living through Jodi Picoults book of Small Great Things where an African American nurse was falsely accused of killing a child of a Caucasian couple. I think the realisation of what happened, the response of my boss and practice manager to the incident has actually just dawned on me and actually made me upset and very angry. I thought I would channel these feelings and educate and hopefully look forward to going to work tomorrow and a future where my chocolate flavoured son won’t have to deal with this as his norm.

 

Thanks for reading till the end, as I try and calm down and come up with a plan of what to do about this tommorow.

Crazy socks for docs!!

 

Mental health affects a lot of us in the health profession as previously highlighted in my blog post about doctor suicide. Wear your odd socks today to show your support and have a conversation about how vulnerable we all are…

The day endometriosis nearly killed me…

I woke up with the most excruciating pain and large volume, sudden onset vomiting. The time was probably a little before midnight as I staggered to my parents’ bedroom to let mum know I wasn’t feeling all too well. As mum is a sympathetic vomiter, i.e vomits when she sees anyone else’s vomit, she kindly advised me to try and small sips of water and she would try to get the floors clean. I had to sit in the lounge room, covered with a little blanket as I tried to deduce what could have made me so violently unwell. I recalled the day well. I had been to school and been home without anything eventful. Dinner was a non-event either and the following day was another school day. Every small sip of water or milk seemed to increase the pain in my tummy and before long I was vomiting again. Mum, although not a doctor, diagnosed a simple case of gastro and told me to try and sleep it off.

After a lot more vomits, the spilled contents gradually changed from food to bilious green and eventually coffee grounds colour with flecks of blood. Only on seeing the blood did mum think it wasn’t’ “gala” (gastrointestinal imbalance) and thought best we presented to the hospital. By now it had been a few hours of ongoing vomiting with me feeling completely weak and unable to walk. We quickly drove to Gaborone Private hospital, as I cried in the back seat, urging her to drive through red lights as the pain was most excruciating. On arrival, almost passing out from the pain, I was immediately sent off for surgery to manage a bleeding peptic ulcer. I remember telling the doctor in charge how much I loved him for the morphine and anti-vomiting medication he had administered.

I was 15 years old at the time and used to having severe debilitating period pains that would often make me miss a few days of school each month. I had had my period the day prior to being unwell, and not trying to miss school again, had inadvertently taken an overdose of ibuprofen to manage the pain and had caused myself to have a bleeding ulcer. My mum and I thought that severe period pains were “normal” aspect of being female and even on post-op follow up with my GP I was informed that having excruciating period pains was an accepted part of being a female.

It wasn’t until being a medical student and having ongoing issues that I was eventually diagnosed with endometriosis. On reflection, I was able to realise that I had suffered and almost died from self-medication of this condition without ever having a diagnosis. I was made to feel that, like labour pains, there is a lot of discomfort that comes with being a female when in fact this is very far from “normal”.

Let my lived experience act as a cautionary tale that not all period pain is created the same. So educate yourself about the condition, there is plenty of information on reputable medical sites and present to your doctor if you have any suspicions that you might have this condition. Like Emma the yellow wiggle let those of us who are 1in 10 illustrate that endometriosis can be managed to some extent and, although it has no cure, it doesn’t have to define who you are.

Other sites to look up

Jean Hailes Website 

Doctor suicide

I have recently completed a book by Dr Pamela Wible in which she responds to suicide letters from doctors and their family members (Link is below for the free audiobook). It’s a sobering statistic to learn that on average in the USA, about 300+ of our colleagues call it quits by their own hands ANNUALLY!!!. Unfortunately, there seems to be similar statistics globally among medical students and doctors. I have read about 8 RIP statements to doctors and medical students in the past few months and saddened to hear that the powers that be respond to such findings as “we need to pick a more resilient bunch next time” which I find completely appalling.

I have as a result tried to figure out, what about medicine drives people to this extreme option in dealing with their stress. It must be the culture of medicine that does this, because I would think that we are all very similar when we start high-school compared to when we finish college. I have come to conclude its either medical education or medicine as a vocation as I will elaborate below.

Medical education

• In Australia, before you are even admitted to the university to start studying medicine, there are multitudes of tests which I understand are to ensure you are indeed the cream of the crop. This is in addition to having to pass your final high school examinations with a very high score or like me also having to do 18months of “pre-medical education” before even starting the medical degree. So, most of the people who are eventually admitted to med school are typically some of the smartest of their cohort with commonly type A personality.
• As the career is basically an apprenticeship model of learning, in that typically your lecturers are also doctors, there is always a comparison between trends of the day and how things were when the lecturer themselves was going through training. “In my days we…… or do they teach you anatomy these days?” are common and sometimes very unhelpful comments from some tutors. This model of training can also leave the trainee very vulnerable to the inherent power hierarchy of their supervisor as their evaluations can make or break speciality training applications for example. There are also many different personalities to supervisors and unfortunately, some are the type that is hell-bent on destroying some peoples careers and with the stroke of a pen, are able to do just that.
• From undergraduate degree to full consultant can take up to 15years or hard work ridiculously long hours of often unpaid work, expensive training and frequent examinations which increase the pressure and stress. This protracted learning can lead people to delay life generally i.e. dating, starting a family etc which obviously with the ever-ticking “biological clock” also adds to the pressure, especially for female trainees.
• Usually, to complete medical school and speciality training, there is an expectation that you will be moving houses frequently to do the different rotations required. This comes with learning new staff protocols, meeting new supervisors, learning new systems etc. Also, the usual contract times with hospitals are 12 monthly which means, you are applying for a job annually with no real guarantee unless you know someone who might know someone. Applying for a mortgage with a 12-month contract is one of the many hurdles one might have to deal with as they navigate everything else.

Medicine as a vocation- this profession is one of the options parents of multiple backgrounds give their kids as career choices. “You can only be/marry a doctor, lawyer, engineer, accountant/banker etc”. So by the time you get to start training in the field, the pressure invariably also starts and can trend up with time. Its also a career where one mistake can cost someone their life, where asking for help or asking for time off is sometimes seen as a weakness or where admitting you need help can lead to a report to the regulatory agency.

Without writing a whole new book about doctor suicide, reading this book and watching the related content has certainly been eye-opening for me. Why read such a morbid book or evaluate such morbid statistics I hear you ask…  well, when you seem to be losing colleagues like flies, it’s important to take stock. It makes you take a closer look at how things are and what got us here to hopefully reduce the risk to yourself, your colleagues, your loved ones and the next generation of doctors. At the end of the day, we often forget the fact that we are all human, doing the best with what we know to somehow help humanity in some little way. And, in doing all that, sometimes it can become too much and there is nothing wrong in asking for help. I am here to listen if anyone needs to chat…

http://www.idealmedicalcare.org/blog/physician-suicide-letters-answered-free-audiobook/

*Kindly share the book and this blog post- it might save a life.

 

 

 

Dear new mummy… reflection piece

I was looking at some pictures taken during my pregnancy and post-delivery of my son 2 and a bit years ago and thought about how much I had grown in that short amount of time. My thoughts, perspectives, and life goals have certainly changed a whole lot since then and having a baby certainly does sometimes throw a spanner in the works. I thought I would pen something I would have wanted to know in those early motherhood moments and share with women who are yet to go through that phase of life.

It will all be okay– I have worked doing obstetrics for a while and working in large specialist hospitals can really skew what you see about pregnancy. Dealing with medically complex pregnancies or being involved in deliveries where everything goes wrong can really be traumatic or make one lose perspective. When it was now my turn to have my own bundle or joy, I was always scared of what could be around the corner despite having no significant medical history or reason to be concerned. Now, things didn’t really go according to plan, if ever there is one, with the delivery but I have ended up with a smart, loving little boy and I couldn’t be happier. Reflecting on my whole pregnancy and delivery as well as all the patients I have cared for whilst going through the same phase of life, I can honestly say that relax and enjoy the journey. Most times than not, things work out okay. Our bodies are great devices that can have a few hearts, brains and limbs growing at the same time and still manage things relatively okay. So trust the body and what it can do…

Give everything time– You would think having been a medical practitioner in the field would equip me with a lot that other people don’t know but I think motherhood is mainly about allowing nature to take its course and following your instincts. This is true with even learning who this newborn person is, their likes and dislikes as they also learn who you are etc. Living in a fast-paced world, we are always looking for instant gratification and motherhood is, unfortunately, something that you grow into and this takes time. This also applies to getting back into pre-pregnancy clothes, developing some sort of routine and getting some form of sanity back after delivery. The other thing is to acknowledge is the impact having a baby can have on all your relationships but with time, you slowly DO get your groove back.

Enjoy every stage– corny as this sounds, this is very true. I remember during pregnancy, wishing that I had delivered already as I was tired of having to pee every few hours and when he finally did arrive, wishing he was able to do stuff like eating, walking, talking instead of just being a baby. Being in the moment can be a bit tricky when you are sleep deprived and covered in vomit but looking back, those stages were each treasure-worthy and sadly I must say I now occasionally miss the times when he was less mobile as I could get a lot done around the house without him following me everywhere. I now though, get to enjoy the language development and the cheeky personality that comes with it and I am definitely in love with this stage of his growth.

Take advice with a grain of salt and then do what works for you– when you are finally pregnant or have a newborn, people suddenly give you a lot of unsolicited advice about everything motherhood related from how to have the best birth experience, how to make them sleep all night, when and how to feed them etc. I remember doing the controlled crying technique to try and get little L to self-soothe and get himself to bed as was being recommended on my sleep help books. Not only did this make him even more cranky, it also DIDN’T work so we had to work out our own way for him to learn to self-soothe. So evaluate every advice you are given and do what works for you and your family.

You will love like you never had– I am one of those people who was very disappointed that I didn’t have that movie moment of love at first sight with little L. I was honestly probably stuck with “doctor hat” on instead of “mummy hat” when I got to see him for the first time and it took a while for me to realise that he was my own little man that I got to keep instead of the many babies I had delivered and gave back to their parents. As I grew into being a mother, and gradually became confident in my skills of safely growing a human, I have come to acknowledge how much I really love the little bugger despite the tantrums, snotty noses and having early morning human alarm clock. He has made me want to make the world better for him as well as make me want to be the best human example be could have.

In summary, motherhood has truly been an AMAZING  and rewarding life phase and I am looking forward to sharing this experience with my sister sometime in the near future…

Hoping some mothers can comment below and let me know what they have learned so far on their own journey…

 

*Picture sourced from Google

Things I wish patients knew…

So there are many things that patients probably want doctors to know about being patients. The good thing is that as doctors, we should ideally all have our own family physicians and therefore we should be patients at some point in our lives. This thus means all doctors have been patients at some point but unfortunately not all patients will be doctors. So I thought I would provide some insight into the world as a family physician and some things I thought would be great to know…

1. Trust me when I say, there is usually a very good reason why doctors run late- emergencies come up, breaking bad news, counselling a suicidal patient, managing complicated medical issues which can be compounded by complex family dynamics, you get the drift. I promise I am not sitting and twiddling my fingers in the consulting room and just giving you a “therapeutic wait” so you can decide whether you still want to see me or not. I would also want to get home on time and for once not have my son be the last one for pick up at childcare but I am here, addressing your medical issues so please don’t be angry at me because I cannot call all those patients who incrementally got me to this stage of late and get them to apologise directly to you.
2. In the same token as point 1, I would appreciate if you could call in advance when running late and even better if you are unable to attend your scheduled appointment so that I can better serve the other patients who were unable to get an appointment time with me on the day.
3. When you take your clothes off, you don’t need to apologise for whatever it is you feel like you need to apologise for- eg not shaving, being sweaty, being fat etc. Unless these are part of your medical illness, I am not really concerned about them. Females are the worst especially when having pap-smears when really all I am assessing are vulval medical conditions and the appearance of the cervix for example. Your legs not being shaved is not even something I look at.
4. Antibiotics are not required for all ailments and no your viral upper respiratory chest infection that is dry but chesty will not be gone by this weekend if I gave you Augmentin duo forte or any other really strong antibiotic you desire. Allow me to take a comprehensive history, examine you and then determine what treatment you need and understand that sometimes good old rest, chicken soup, Panadol might be all you need.
5. Asking to be bulk-billed at the end of a long consult when not on a health care card and having been told at the time of booking the consult about the fees of the consult is the same as going to a fine dining restaurant, eating a degustation course and then when the bill is presented going on to ask for a 50% discount. I don’t like making a big deal about finances especially when I have patients waiting but I hope you understand that halving my income doesn’t mean I only pay 50% for my groceries, mortgage or everything else that my family and I need. If you are not keen to pay out of pocket for medical consultation, in Australia the good thing is that there are strict bulk billing clinics that happily provide that service. I am happy to provide that service if it is agreed and understood from the beginning of the consult.
6. If your child has a fever or pain, giving them paracetamol and having their fever or pain settle won’t make me not believe that they had it to begin with. Having a grizzly child with a fever or pain that has been going on for hours or even overnight just so the doctor can see how high their fever is or how uncomfortable they are amounts to cruelty in my eyes. Just tell me that you gave them some pain relief and I will still take a history, examine them and take it from there.
7. In the same token as *6, telling me you have 10/10 pain and you have not had any pain relief and you were playing on your phone when I walked into the waiting room makes me question whether you understand the pain score to begin with. If I say 10/10 is being burnt alive, you are saying you are being burnt alive and choosing to still be playing on your phone and not take any pain relief which doesn’t make any sense to me. Also, don’t tell me about your pain threshold- I just need you to score your pain out of 10.
8. Doctors are human too and sometimes they get sick and have to have time off work. Sometimes they have to attend to family emergencies such as sick children and have to take carers leave etc. They also need to have time for holidays and this should not be laced with guilt. Doctors who attend to patients when they personally are sick or who can’t even have time off to do other life things run the risk of burnout. This can eventually lead one to stop practicing medicine altogether. So appreciate it if your doctor does take the time to attend to do these things as it illustrates that they are indeed only human after all.

These are the few that I can remember at the time of writing this list. I am sure there are many more and a whole lot more patients would like their doctors to know. Feel free to comment below if you have anything to add

*Comments and opinions above are mine and don’t reflect the opinion of any medical clinic or college I may be affiliated with

*Image sourced from Google