Jennifer Frank, MD: Vulnerable to stress?

I recently took an online quiz to assess my vulnerability to stress. I was anxious to identify those areas that I needed to improve in order to lower my cortisol-induced stress haze.

I scored a perfect score of invulnerability. Seriously – I didn’t even fudge any of the answers. The questions were things like “Do you get regular dental care?” and “Do you get seven to eight hours of sleep at least four nights per week?” It didn’t even ask if I have kids! Needless to say, I don’t believe that quiz. I am vulnerable to stress, and I feel it on a fairly frequent basis.

These are my stress triggers:

1) Over-commitment. It is my modus operandi to say “yes” too frequently. As a result, I get stressed by competing appointments and demands.

2) No breaks. In medical school, you were better and tougher if you didn’t need to sleep, eat, or use the bathroom during a call shift. This has translated into marathon workdays in which I down a Power Bar on my way to the bathroom in a twisted unhealthy multi-tasking spree. Don’t even get me started on how the mother of four small kids is supposed to take a shower.

3) Perfectionism. Doctors are expected to know everything, do everything, be everything. Actually I think this is just what we expect of ourselves. During those (too frequent) times I have had to confess an error or mistake to a patient, they are much more forgiving of me than I am of myself.
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In looking at my quiz results, I realized there are a number of stress insulators – things that protect me from stress. Probably would be a good idea to maximize these areas. According to the authoritative stress vulnerability profile, this is what I have going for me to keep my stress to a minimum:

1) Healthy lifestyle habits. Okay, I admit to eating half of an apple streudel dessert and a handful of barbeque flavor rice chips for breakfast occasionally, but in general, I eat healthy, exercise, and get as much sleep as my children allow.

2) Friends and family. I do have a “four o’clock in the morning” friend (you know, the person you can call at 4 a.m. with any concern minor or serious) and am fortunate to have family close by.

3) Comfortable lifestyle. Physicians (even primary-care physicians) make a great salary. This enables me to afford all kinds of stress minimizers like dental care, babysitters for date night, and even a cleaning service for our house.

4) A strong marriage. A poem that hangs on the wall of our bedroom describes it perfectly: “You are the strong embrace in my challenge.”

5) Finally, spiritual grounding to give it all meaning.

You probably have your own list of stress inducers and stress deflectors. It is crucial to avoid those things that cause stress while soaking in the wonderful parts of life that reduce stress.

Jennifer Frank, MD: Crazy busy

I am sure you can relate to the sense of being crazy busy – not just rushing from this thing to that but feeling completely overwhelmed with the multiple professional and personal commitments that line up, seemingly endlessly, before you. I am living this, and it’s not a comfortable place to be.

About six months ago, I was invited to speak at a conference occurring this past weekend. I enthusiastically accepted. It was a great opportunity which I thought would be personally enjoyable and professionally enriching. As the date got closer, the stress of actually preparing for and getting to the event outweighed my excitement. It didn’t help that I was flying out on my husband’s birthday or would be missing my daughter’s dance recital.
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My mixed feelings about making these personal sacrifices for a professional honor showed up in a late departure for the airport, poor concentration for the task at hand necessitating a U-turn to head back home to retrieve my forgotten thumb drive, and a series of mix-ups, hold-ups, and circumstances that had me arriving at the conference about 30 minutes prior to my talk (causing a minor panic attack for the poor woman organizing the conference).

After the talk (which went well despite the inauspicious events leading to my arrival at the conference center), I had time to reflect on my “balance” which was feeling quite out of whack. As I enjoyed the absolutely gorgeous scenery that spread out before, I had time to do something I rarely do – breathe deeply and ponder deep thoughts. I came back to something that has occurred to me on previous occasions when I find myself overwhelmed and underfocused: I am trying to do too much.

I was well prepared for the talk and excited to give it. I had allowed some wiggle room in my schedule, which I did have to use. However, I still arrived with (some) time to spare. My husband, left in charge of kids, house, and pets for the weekend, was supportive of my going, even on his birthday weekend. I was, however, trying to balance my professional role with the guilt of choosing to be away from my family during a time we would normally have spent together (our weekend).

Instead of accepting this as the necessary cost of pursuing a professional opportunity, I was going back and forth in my mind between my role as a physician and my role as a wife and mother, feeling unprepared for one role and guilty about not doing the other well.

In reality, I was upset that I couldn’t have it all – you know, being the star speaker of the conference while also being a perfect wife (home for her husband’s birthday) and mother (clapping enthusiastically in the front row at the recital). In the future, I will need to do a better job accepting that choosing one thing (a speaking engagement or staying home to attend a family event) is often choosing not to do something else. That is the cost of the choice, and consciously deciding to pay that price (or not) will hopefully prevent some of the guilt and a sense of imbalance that can accompany crazy busy weeks.

Jennifer Frank, MD: A reflection on me

I recently had to readmit a patient to the hospital for pneumonia. A lovely and delightful woman, she happens to have severe COPD exacerbated by continued smoking. She knows she shouldn’t smoke. I know she shouldn’t smoke. I know that she knows that she shouldn’t smoke. We have been over this countless times.

Speaking to the pulmonologist about her care, I was informed that she needs to quit smoking. I became embarrassed that my patient was still smoking, as if I was somehow responsible for this behavior. I have been scolded by consultants on other occasions when my patient was rude to the nurse in the hospital or didn’t keep a follow up appointment. Sometimes the consultant catches herself before continuing the tirade, and sometimes my therapeutic relationship is perceived to be so close with my patient that the patient’s behavior becomes one with my own.

Really it boils down to a blow to my professional pride.
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I cringe to call a specialist on those patients who continue to abuse their own bodies, eschewing medical care until they are practically in extremis. As a primary-care physician, I pride myself on the close relationships I establish over months and years with my patients. However, sometimes my role as the family doctor seems to carry the responsibility for my patients’ actions along with it.

I liken this to what happens when one of my kids goes to school with a stain on his shirt or her hair uncombed. This doesn’t happen most mornings, but occasionally, the juice spills on the shirt at breakfast and I don’t notice the stain until dinnertime. Or, in the mad rush to get out of the house I assume my husband will brush the girls’ hair and he assumes I will and then the bus is there and the opportunity is gone. When this does happen, I wonder if the kindergarten teacher or classroom parent thinks I am careless. I am already suspect as a working mother, so maybe this adds fuel to the fire of speculation about my commitment to my family.

There is an understandable element of pride in how our children behave, appear, and are regarded. We all want to have the most beautiful, talented, polite, and exceptionally bright kids. When our children make the inevitable mistakes or fail to practice the basic elements of personal hygiene, it is challenging as a parent to not inwardly wince at what this says about us.

It is similar being a primary-care doctor. I take pride (or not) in my patients’ performance – if their A1Cs are below 7, this not only reflects what “good” patients they are, but also what a “good” doctor I am. But just like we can’t pick our kids, we can’t pick our patients. So, I must deny the pull of professional (or parental) pride and accept my patients just as I accept my own children – as imperfect people who look to me for help and often for approval as well.

Jennifer Frank, MD: Discipline

While swimming this morning, I entertained self-congratulatory thoughts about my dedications and discipline. I got up this morning early to go to the pool before work. Okay, in all honesty, I slept through my alarm and was awoken by my youngest one’s cry to be rescued from his crib. Because I didn’t go back to bed like I wanted to, I count this as a plus in the discipline column.

I thought further about how I am trying to follow a workout routine (parts of which I really don’t like) in order to prepare for the triathlon. I have a workout schedule that I follow pretty faithfully. Having it written down in black and white seems more inviolable than just having an idea of what I planned to do in my head. I could continue with this illustration – swimming is methodical repetition of the same thing over and over again and involves “staying in your lane” while doing it. Both of these ideas have application for parenting and being a physician.

I recently received a rather strongly worded e-mail from the Wisconsin Medical Licensing Board stating that I (and all other licensed physicians) should read the quarterly newsletter to find out about new information that applied to our licensing. I ignored the first e-mail but did take a few minutes to read it after the second e-mail arrived.
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I never found the new information but I read with morbid curiosity about all the board actions against physicians occurring over the last few months. Truly shocking and surprising in both quality and quantity. Having sex with patients, dispensing vast amounts of controlled substances to patients or yourself, gross negligence.

Reading through this newsletter of shame, I realized why professionals need to have specific guidelines (you have to wait two years after termination of the patient-physician relationship before initiating a romantic relationship with a former patient, you cannot prescribe yourself or a close family member narcotics). These both seem pretty obvious, but I think it is easy to fudge the lines slowly, gradually, and unintentionally over time, so that you are no longer “swimming in the right lane.”

Just like the difficulty in getting up super early to immerse yourself in cold water, it can be difficult to adhere to standards when a questionable case is before you or when your own “needs” seem to be so compelling.

As a parent, self-control and discipline are important as well – not only to teach to your kids, but also to demonstrate yourself. It can be so hard to be consistent when you are tired, overwhelmed, or just at the end of your rope. It often seems easier to give in to their demands than to take the more challenging role of parent – in control and the same today as yesterday.

In all my roles – as fledgling triathlete, family physician, and mom – it is essential that I not only practice self-discipline but also recognize my own natural tendencies to fudge the lines when it is convenient to do so.

Jennifer Frank, MD: An "oops" of epic proportions

An acquaintance recently reminded me of a painful episode in my parenting history. “I was telling someone about you yesterday,” she started. “My friend was giving me grief for not bringing our daughter to the doctor right away when she had a wrist fracture. I told them that you missed your son’s clavicular fracture and you’re a doctor.” Ouch.

Two summers ago, our oldest son was playing with a friend while we were attending a minor league baseball game. His friend swung him around and let go. Our son landed on his outstretched arm and started crying.

My husband brought him back to where I was sitting with our daughters. He seemed like he was in a lot of pain, but it was hard to tell if he had fractured something. I palpated along his humerus, rotated his hand back and forth, looked for swelling. He could move his arm but said his shoulder hurt. It wasn’t dislocated and I couldn’t find anything specifically wrong. So, we comforted him with cotton candy, stayed for another 30 minutes to watch the end-of-game fireworks and headed home.
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Our son alternately appeared totally fine and then would start crying and complaining about his arm hurting. On the drive home, my husband and I debated the necessity of a trip to the ER. I did a more careful exam in our kitchen once we arrived home. He was guarding his arm a bit but told us that it felt better. It was late and we were all tired. I imagined how we would be triaged on a busy Saturday night in the ER and pictured waiting with a sleepy, cranky kid for hours. We gave him some ibuprofen and put him to bed, planning to take him in the next morning if it was still hurting him.

By the next morning, he seemed better. He was playing happily in his room. Every once in awhile he would complain of his arm hurting, but as he tends to be overly dramatic at times, we weren’t sure how much he was actually bothered by his arm. I would spy on him as he played Legos to see if he was using that arm or not. He seemed to hold it close to his side but would use it if needed. I still wasn’t sure. We decided to keep observing him.

By Tuesday morning when he was still complaining of arm pain, we took him to his family doctor. Unfortunately, he had suffered a clavicular fracture. Fortunately, he had self treated it by holding it flexed and close to his body. He was fitted with a cool-looking arm sling that offered a little bit more protection until the bone healed itself.

Of course, my husband and I both felt terrible, and still do, that we – two physicians – missed this in our own child. However, it helps me to comfort my patients’ parents when they too miss something and serves as a good reminder why I don’t doctor my own kids.

Jennifer Frank, MD: Consequences

Sometimes being a doctor is like being a parent. You worry about your patients, you lecture, you cajole, you warn. Sometimes your patients act like children (and sometimes your patients are children). They do what you tell them not to do (“I told you not to drink while taking the Flagyl.”). They don’t really believe you when you tell them that if they don’t get their diabetes under better control, they will be starting dialysis. They often look up to you, respect you, and see you as an authority.

As a parent, I maintain a careful balance between preventing and allowing consequences. My kids are young, so I still have this power. “If you miss the bus, you will not get dessert tonight.” Action leads to consequence. I can also intervene to prevent the consequence. “Okay, you forgot your lunch, I will drop it off at school on my way to work.” I realize that as my children get older I will be less able to protect them from the consequences of their actions. This is one of the hard parts about being a parent.

As a doctor, I have less control over consequences. My interactions with patients are, in the grand scheme of things, relatively brief. I also am paid and duty-bound to prevent consequences – I don’t allow a person to get lung cancer to prove that smoking is actually bad for you. I do everything I can to prevent lessons from being learned the hard way.
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Despite my best efforts, consequences often find my patients. The years of overeating and lack of physical activity eventually lead to diabetes. Forgoing the statin and continuing to smoke leads to a second heart attack.

During a recent discussion with one of the senior residents, she revealed the struggle she is experiencing with seeing a patient suffer the consequences of a poor choice. The resident did everything right for her young teenage patient. She counseled her on safe sexual practices, the value of delaying sexual activity since she was so young, the need for contraception and barrier protection should she make the decision to have intercourse, and the importance of being prepared for “heat of the moment” decisions.

Despite a close therapeutic bond, despite a parent who was accepting and supportive of her daughter’s decisions, despite a prescription for contraception, this young girl is pregnant. The resident did everything right but could not save her patient from the consequences.

This can be heartbreaking as a doctor (or a parent). You wonder where you went wrong, what you could have said differently, if you missed something that could have prevented this from occurring. The sad fact is that our control (as doctors and as parents) is uncertain and often almost completely absent. We have influence but little actual power. Where we do have power is in our presence – walking beside our child or patient (or friend, sibling, spouse, or parent) as they face a consequence. As a family physician, this is a role I gladly and willingly take.

Jennifer Frank, MD: Breastfeeding... at work

I have breastfed all four of my kids. I strongly believe the research – breast is best. It is the healthiest nutrition for babies and provides long term health benefits. It is healthier for mom allowing the average mom to consume an extra 500 calories a day. A definite fringe benefit!

Returning to work at six to 12 weeks after the birth of each child, I have pumped at work, on call, while traveling, and even on the road one very chaotic day. Both personally and professionally challenging, it causes me to appreciate why so many of my patients give up breastfeeding shortly after returning to work.

I breastfed my first child until he was five months, having to wean him rather quickly in anticipation of a deployment to Afghanistan that fortunately never occurred. My second child “fired me” after eight months. She was and remains a daddy’s girl and I secretly think she preferred a bottle from dad to milk from mom. My third child was 14 months old when we gave it up by mutual agreement. Number Four is a tenacious breastfeeder, continuing to almost exclusively breastfeed at eight months, despite our daily attempts to convince him of the benefit of eating cheerios, squash, or oatmeal.

After doing this four times, I have learned two important things.
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You must allow time to breastfeed or pump. This means getting up a little early (if my husband is reading this, he is probably snorting with laughter as he usually gets up over an hour before I do and brings me coffee in bed), carving out time in your clinic schedule to pump, and taking frequent breaks no matter what you are doing to breastfeed or pump – whether you are teaching at a conference, in the airport, or at a restaurant.

I have found it helpful to make a 15-minute appointment with myself in each half-day of clinic to allow me time to pump. This gives me enough breathing room to actually get it done, despite a hectic schedule. Sometimes I have to leave a meeting early or arrive late so that I can take care of what needs to be done.

One thing I struggled with was how to inform colleagues, staff, and residents what I was doing without making them uncomfortable. I heard about one woman who had a picture of a cow she would hang on her office door whenever she was pumping to let everyone know she was occupied. That seemed a little too strange and self-deprecating to me (what new mom wants to be compared to a cow?!?). I made a laminated sign that informs people of what I am doing and how long I will be gone that I put on my chair in clinic when I head off to my office to pump.

It is not easy to continue to breastfeed once you return to work. Like every other aspect of combining the personal and professional gracefully, it requires patience, planning, persistence, and practice.

Jennifer Frank, MD: Making friends, Part 3

I have previously written about the struggles I face as a busy, working mom to establish close friendships, or let’s face it, even loose friendships with other moms like me – moms who spend most of their time away from the people that are closest to their hearts.

I joined a meetup.com group to meet other working (outside the home) moms and have been pleasantly surprised by the result. No bosom buddies yet, but I have enjoyed the few activities I have attended. I am even hosting my first event this weekend – a movie afternoon at our house. Friday night will find me madly cleaning the toy room in order to create the illusion that in addition to working full time and parenting four young kids, my house is always immaculately clean.

Last night, I had the opportunity to do something I normally avoid like the plague (or agree to attend and then spend the days leading up to the event inventing ever more fabulous excuses for canceling). There is a new surgeon in town and she is a girl. She hosted a meet and greet for other female physicians at a local restaurant.
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I get a fair number of invites to meet new physicians or see new office space or hear about new services. Usually, I am not even remotely tempted to give up time with my family to attend. However, when I received Dr. Collette’s invitation in the mail, I decided to go. Maybe it was the hot pink lettering and zebra print background on the invite. It might have been the informality of combining the “Doctor” title with her first name – not since I lived in the south have I been “Dr. Jen.”

I think, though, it was most likely the little note that accompanied the invitation. It described the benefits of female providers meeting, working with, and supporting other female providers. I like that. I wanted to meet this lady. Most of all, I wanted to reward her outreach effort by accepting the invitation.

So, yesterday evening, I headed out to the reception. I admit that I regretted having accepted as I drove to the restaurant. I would have preferred to head right home even knowing that dinnertime chaos awaited me. But, I reasoned with myself, I accepted and wasn’t sure how many other physicians would take the time to go. I also told myself that there were probably other female physicians in my place – busy with work and home and eager to meet other people with whom they share a common bond.

I took an immediately liking to the new doc in town – approachable and down-to-earth. I also had the chance to meet a half-dozen women doctors. One even brought her 9-month-old son – another bond. It was nice to converse with these fellow physicians and moms and wives and women.

It has inspired me to get together with my practice partners and host our own female physician get together. I will let you know if anyone accepts our invitation.

Melissa Young, MD: My biller, my husband

After having paid about 10 percent of collections to our billing department when I was at my old group practice, I had to make a decision about who would do the billing for my new practice.

I had found a couple of billing companies that would take less (heck, no one I know has a company that takes 10 percent). But even 5 percent seemed like a lot. And I was pretty jaded after my prior experience. You know there was a time that our collections were way down one month, allegedly because the person responsible for our billing went on vacation and stuffed our billing slips in a drawer instead of delegating them to someone else.

Plus, anything less than $10 was just written off apparently. I know $10 may not seem like much, but let’s say that even two patients a day owed $10, that’s more than $7,000 a year! Now, I understand, if you’re paid hourly, you don’t care if you collect $10 or $10,000, you shuffle your papers and make an occasional call, but if you get a denial, then so be it.
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So, after careful consideration, we (meaning my husband and I) decided that my husband would do my billing. After all, other than me, who else truly has an interest in how much gets collected? Who’s going to look at every claim, every invoice, every EOB? And who’s going to figure, yes, it is worth the 44-cent stamp to send that statement for $2.29.

Now my husband’s not a biller by trade. But he took the requisite courses and is proficient at math, and quite honestly, I think he’s got a little obsessive-compulsive trait in him. This of course is great in a biller. But my husband also has a full-time “real” job, and because of my hours, he is also a very hands-on dad. So he does the billing during his lunch hour (he’s always grateful for the drug rep lunches), in the evenings, and on the weekends.

We had some technical difficulties at first, as he learned the practice management system and our clearinghouse’s software, but he has it down pretty good now. Sure, he gets frustrated at making phone calls to insurance companies, especially when he can’t get a human on the phone (which is all the time), and the phone calls from patients who say they shouldn’t owe anything because they have a secondary insurance (which would have been good to know when they came for their visit).

But he says, strangely enough, that he kind of likes doing my billing, and I like having him come to the office everyday. And if the time ever comes that the world doesn’t need engineers, he has something to fall back on.

Jennifer Frank, MD: My voice

I have laryngitis. This is my first bout with the sickness that takes your voice. I can squeak out a few words before I start coughing. I can whisper pretty well for several sentences before I get tired of whispering or my audience gets tired of trying to hear me. However, I am definitely unable to continue my current voice-related duties.

At home this weekend, I had to discipline without my voice. This led to two things. First, I let some things go that normally would have found me yelling either up or down the stairs to “stop chasing each other,” “brush your teeth like I told you to three times already,” or ask “is your room clean yet?”

Second, I got a lot more exercise since I had to physically locate myself in the same room as the kids if I cared enough about their current infraction to reprimand them. That tired me out quickly. So, I found it easier to just hang out wherever they were. This allowed me to watch them more closely which made it less necessary to correct them as my proximity had a disciplining effect.
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The unintended effect was that I spent more quiet time with my kids — my daughter read me a story, I taught my other daughter how to play Connect Four, I explored all of the Lego weapons my son had repurposed into even more powerful weapons, and I got some great belly laughs out of my infant son.

At work on Monday morning, I had to critically evaluate my schedule. Clinic on Monday afternoon would prove challenging for both me and my patients if I had to whisper through questions and instructions. I reviewed my appointments and was able to identify which ones needed primarily my hands or eyeballs and would allow minimal conversation. Not surprisingly, I determined that most actually needed to hear me, so they had to be rescheduled.

I couldn’t pick up the phone for the telephone conference I had planned, that would need to be rescheduled. I had a couple of important meetings to attend — both requiring at least some input from me. I considered writing down my thoughts, but was able to express everything I needed to say with a few well chosen words, thumbs up or down, and a few shakes of my head. At the conclusion of both meetings, I felt that the things that I needed to communicate had, in fact, been communicated. It is both humbling and embarrassing to consider how many more words I would have used had it been easier to do so.

Being quiet today has other benefits. When I did speak, everyone listened. They wouldn’t be able to hear me otherwise. Ironic — I usually raise my voice to be heard better. I also feel more quiet and calm. I am thinking before I speak (a rarity) because I have to save up my words to exert maximum effect. It is evident that this would be a good practice every day.

Jennifer Frank, MD: CME ... with baby

It seemed like a great idea at the time. You know, like a year in advance. I applied to present at the American Academy of Family Physicians Annual Conference. Between the time I applied and the time my presentation was accepted, I discovered (happily) that I was pregnant.

My new baby would be about 3.5 months at the time of the conference. I figured it was doable and set out to make the arrangements to attend (along with my husband and three older kids). As an academic physician, it is important to keep publishing and presenting, even when life is happening.

A few weeks into my maternity leave, I found myself madly putting the finishing touches on my presentation. In between diaper changes and breastfeeding sessions, I did pub med searches, printed up articles, and finessed my PowerPoint presentation. Shortly after returning to work, I practiced my presentation for colleagues, received their feedback and made the necessary changes. I uploaded my “finished” presentation the day before we were to fly to Boston. I was ready for the presentation. I wasn’t so sure, though, about traveling with four kids on a plane, staying in a hotel, and navigating to the conference every day with a baby in tow.
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We arrived in Boston on time and got settled into the hotel. Fortunately, I had realized, in a rare moment of sanity, that once I left work on Monday evening, I would not have a chance to practice my presentation again before I did it live. So, there was no pressure trying to fit in one more practice or rewrite before my session was scheduled. My wonderful husband took all four kids on the day of my presentation so that I could focus.

And, it went great. The room was packed with interested colleagues, my talk went well, and I had the chance to connect with other family physicians who shared my interest. My husband even walked our kids past the room where I was talking so they could see Mommy.

For the rest of the conference, I had a guest attending with me — my 3.5-month-old son. We attended CME lectures together (when he allowed it), strolled the convention center floor in search of gadgets for his sisters and brother, met up for lunch with friends from residency and past jobs, and spent a lot of time waiting for an opening in one of the very few restrooms with a diaper changing station.

I was apprehensive about bringing my little guy with me to a professional activity. As a working mom, I often feel pressure (mostly from myself) to keep personal and professional roles separate. This represented a definite merging of the two. However, it went remarkably well. I received mostly encouraging smiles and comments from my family physician colleagues at the conference. I was grateful for the CME I did manage to attend. I was proud of my husband and I for attempting something so challenging…and succeeding.

Jennifer Frank, MD: What I love

Recently, I have rediscovered two old loves – soccer and ballet. Starting with a somewhat flighty dance instructor when I was three, I took ballet until I was in college. The discipline of the exercises and reassurance of doing things “the right way” is satisfyingly attractive. (Is it any wonder I found my home in medicine?) Soccer was a given in the suburb where I was raised and I dutifully played from elementary school until college.

With my focus on pre-medicine studies and the need for excellent grades to get into medical school, soccer and ballet fell aside as I pursued my ultimate goal of becoming a doctor.

In medical school, the work only became harder and the limits on my time and energies more stringent. The second year of medical school closed and I saw the end of heavy-duty “book” studying, but quickly transitioned into all-night call shifts and real-life learning from patients. Completing residency before the 80-hour work week rule, I remember 100+ hour weeks that found me asleep on the desk on L&D.
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During a “light” rotation in residency, I signed up for a four-week pottery class to rediscover a part of me that wasn’t related to medicine. I managed to attend two or three of the sessions, but didn’t have time to go back to get my completed projects. All that is left of my lessons are clay encrusted tools on the back of a garage shelf.

After residency, I suddenly had a lot more time and money…for the two months between graduation and the birth of my first child. Four kids later, residency a fading memory, and a more predictable schedule, I realized that if I don’t reclaim old passions and discover new ones now, I will next be exploring extracurricular options in my assisted living facility.

So, I signed up for a ballet class at the local Y and accepted an invitation to play on an over-30 women’s soccer team.

My ballet classes, open to adults and teens, have been populated solely with young women who have been alive for a shorter amount of time than has elapsed between now and the last time I donned tights. I can only imagine what they think of me as I glide through plies and pirouettes. Despite the limits of my older body, I love it. I look forward to my ballet class with eager anticipation every week. Gone is the need to be the best in the class. I am doing it simply for the love of doing it.

I am similarly enjoying soccer. We are not a great team. We lose every time and rarely score a goal. Once again, there is no pressure. Our team is not striving for a playoff title and no one is trying to shine in order to secure a college scholarship. Sitting on the bench for a few minutes is a privilege not a punishment.

I have finally finished my training and found a job that combines my interests and abilities. I am married with kids. I am terribly busy, but have learned not only the importance, but the absolute joy of reconnecting with a long-forgotten part of me.