Mumma Pod

I had a conversation at work which has left me rather unsettled. It was not the heated debate with the male misogynistic consultant (MMC) about victim blaming in cases of rape, that has left me unsettled. I am proud of challenging his views – I didn’t win but I didn’t let sexist dogs lie either!

It was the conversation in which he relayed that I had upset the female PA who joined in the debate because I didn’t agree with their views and offended her religious sensibility! Because I was standing up for rape victims!!

The conversation started thusly

MMC: I’m not saying that women shouldn’t be allowed to wear what they want . . .

Me: You need to stop talking now!

MMC: BUT . . . essentially the next 20 minutes was them telling me that men can’t help themselves if they see flesh and women should conform to societies standards or put up with it if someone attacks them.

So to be clear my stance is that no one should be attacked ever – violence in any form against anybody is not OK.

The blame lies solely on the perpetrator regardless of if it is;

• a women walking home alone after a night out in skimpy clothing
• a man wearing the opposing teams sports strip
• a person wearing a piece of clothing marking their religion or culture
• a teenager wearing the wrong school tie

While I do tend to dress within societies expectations of me. I wear smart clothes to work and a suit to job interviews, I would wear a posh dress to a wedding and a bikini on a beach. But I don’t think that any one should be judged if they choose not to conform to these norms and they certainly bear no responsibility for the actions of other people. Here is a good sketch illustrating ridiculous ‘she was asking for it‘ becomes if you apply it to other situations.

I am astounded that more men are not up in arms against the argument that men can’t be held responsible for their actions if a bit of flesh is on show. Are 50% of the population barely containing themselves from violently attacking the other 50% at all times, is all it takes to upset the status quo a bit of flesh. If so then how do they cope at the beach or swimming pool and why is rape still common place in countries where women habitually cover up more than in the west?

On other hand what if a woman wants to attract a sexual partner when she goes out for an evening, in dressing to be alluring to the opposite sex does she waive her right to choose who that partner is?

There is always in life a bit of a grey area. I’m not talking about if the woman was drunk or had been kissing the guy earlier in the evening – if a man can tell when its appropriate to give someone a cup of tea then the same applies to sex. There maybe a situation though where a woman consents at the time, but could feel regret and shame to the point that they claim it was rape to save face. Rape fantasy is surprisingly common, but not I suspect because the woman actually wants to be rape, but this is the only way she can assimilate certain sexual fantasies will what society dictates is decent! Even in this case though the blame lies not with the woman, but with the society that has shamed her. Why is a man celebrated for his sexual prowess and a woman slut shamed. The sexism is in the double standard – if society wants to celebrate celibacy then it must apply to all.

Similarly what is said about a woman who wears jeans, a loose fitting shirt and flat shoes to go out – that she had made no effort? She should have more pride? Take more care of herself? But that is what men wear on a night out . . . perhaps we will know equality is really here when women having the right to wear what they want means just that and not to impress a man or conform to society – for now though isn’t it easy? Just do what THEY say and ‘be a lady’!

The looming FRCS exam was one of the scariest obstacles when I was considering my place in medicine. Was is it worth putting myself through it? However would I manage it when I could barely remember the chapter title let alone the fine details. Was it worth putting my family through that?

Now I am smugly sitting on the other side, yes it was. Also I managed to have a good time with my kids, I ignored my male colleagues who ‘helpfully’ informed me they saw their kids for 30 minutes a week during FRCS prep – I was not prepared to do that and it is not necessary!

Anyhoo, hear is how I survived . . .

First the study strategy.

The best advice I was given was:

1) Read Miller (or your summary book of choice) from cover to cover in a week (I think it took me 10 days). – this is so you know get an idea of what you don’t know, not to learn anything!

2) Study what you DON’T like first. This is so that when you are tired of the books you have what you like and understand already to revise (a wise consultant once told a colleague of mine – ‘It is only revision if you have learnt it before!’).

By the way the worst advice is – ‘read 10 pages of Miller every day from the start of your training’. Miller is so dense that I found 10 pages practically impossible at the height of exam study. If you are early on (and keen) try for 1 page most working days – you’ll have still read the whole thing twice over by the time it comes to start studying!

Part 1 and part 2 are different beasts. Part 1 you need all the annoying details, BUT the answers are written there for you – so work on understanding the principle and only knowing the name of the gene or obscure syndrome well enough that you will recognise it written down! Part 2 you already have the knowledge. Now you need to tell the story – structuring the verbal response is the key here and this needs a LOT of practice! Also while evidence based practice is essential I not disputing that, but remember in the exam knowing the paper lifts you from a 7 to an 8!

So for part 1 I dedicated 2 weeks per chapter in Miller. During this time I re-read each paragraph but aimed to understand it and read around it using orthobullets mainly. I did NOT use papers as it confuses the situation. I made flash cards of the details to remember – if you are lucky to be reading this early in your training start now! Everyday I would review the flash cards I wrote the day before and also on that day last week. So each card automatically got 3 viewings – say I wrote it on Monday, I would then revise it on Tuesday and the following Monday.

If you are struggling to get into studying, or you have enough time before you exam, try writing just 3 cards a day – 1) Anatomy 2) Basic science 3) Pathology BUT concentrate on one small aspect – one muscle, one concept in basic science or just the aetiology of a disease. In fact I would strongly encourage you to do this with anatomy and basic science regardless of if your exam is close just spread these chapters out alongside the others. I found it much easier to remember muscle insertions when I studied them one at a time rather than trying to do a compartment all together. I even split my week lower limb one day, upper limb another, axial, vessels and nerves.

The final four weeks before the exam I dedicated to practice questions and reviewing my cards. Anything I found I didn’t know or understand I would look at more closely again, but it wasn’t that much by that point.

Part 2 I wrote myself mind maps for each disease or concept, like some kind of crazy person these were taped to my bedroom wall. I would go along the wall – look at each map, turn around and try and talk out loud about everything on it. As I went along I would add new things from the evidence or discussion with consultants etc in different colours.

So the evidence this is the icing on the cake. You will not fail if you don’t know the name of the paper but understand the concepts and demonstrate understanding. I really learnt the evidence for a few high tailed topics and was delighted when one of these came up, BUT by the time we had covered the questions I did not have time to talk much about the literature. I think I managed to drop one or two mentions of papers in as I was talking through my answers – I hope anyway its all a blur now!

The myself and a post FRCS friend met every night and during breaks at work and PRACTICED til I was blue in the face. Every list and every clinic I asked to be grilled.

Second finding the time!

So I tried to have 10-15 hours to study a week. I did this with 1.5 hours a night after the kids bedtime and 3 hours each day at the weekend. Also squeeze every drop out of the day – if you can go to work half an hour early to study (before work is never quality family time in our house), read your flash cards or question books between cases (or in the car on a family trip if someone else can drive), check orthobullets when waiting to discuss something with the boss, listen to pod casts on your commute or taking the baby for a walk (Miller but also from the Journals will give you an overview of some of the current papers), orthobullets questions while breastfeeding, make play dates with colleagues and get grilled while they play!

Although I am definitely a night owl I prioritised sleep over more revision time as it is essential to retaining what you have learnt (for more information on this read Why We Sleep by Matthew Walker).

Finally motivation!

Telll yourself you are going to 10 practice questions and that is it – then you can stop. Once you are at your desk you will keep going, it is getting their in the first place that is the barrier – well it was for me anyway.

The most galling bit was, after all the hours of work done, money spent and numerous guilt trips, the note that arrived to tell me that the pin was currently out of stock! I now know that everyone gets this note, but I felt so aggrieved that despite all the toil it represented – they couldn’t be bothered ordering the pin. I REALLY wanted to wear that to ARCP 🤬, I mean when else will I wear it?

One of my great role models as a surgeon once told me that she heard women saying they felt like rubbish surgeons and rubbish Mum’s, but she felt that she was killing it at both! While I try to emulate her I fall solidly in the camp of feeling a failure in every area of my life and in this respect I know I am not alone!

At a women in Surgery conference I heard the advice. ‘Be the best surgeon you can be and a be a ‘good enough’ Mum.’ Initially I was shocked but I think there is some truth in this. My kids seem to love me to the moon and back rather than pick me up on my perceived failings!

Being a good surgeon is not about taking on every project or role suggested. Only do what is useful for you – I have always wanted to be a hand surgeon and therefore should have never wasted my time on a systematic review of acetabular fractures for example! Collaborate with others and maximise your studying efficiency.

My mum say’s that my sibilings and I turned out well despite our upbringing rather than because of it. I think that if your children get your attention when you are there then they will feel the love. They will hopefully grow up proud of your achievements once they are old enough to understand why mummy couldn’t always come to the park.

I find the best way to please my kids are the little things. Actually look, when they show me a picture/ model/ ninja move. Listening to their chat for 5 minutes at bedtime. Setting aside 15 minutes at the weekend when they get my undivided attention. We have a family disco night that the kids LOVE and I make sure that I strut my stuff hard enough so that it counts as cardio too!

I think we also need to realise that priorities vary day to day. We might refer to it as work-life balance but in reality it is a pendulum swinging this way and then then the other. At times work has to rightly take priority e.g. exam time, covering on call, the supracondylar you need to be signed off level 4 and unexpected sickies. Other times you must give more focus to your children e.g. when they are sick, starting school or first nativity etc. Another good analogy as that of all the balls that we juggle some are rubber and will bounce if dropped, but on any given day you have a few glass ones – give your priorities to catching these ones!

As a working mum you may as well accept from the beginning that you won’t make every performance, award giving or sports day, (you may need a large glass of water or gin to swallow this particular guilt pill) but your children are resilient, forgiving and most importantly forgetful! Think about it – how much you really remember of your childhood? Although I do live in fear my children will have Hyperthymesia (even then most of the handful of people diagnosed with it were more than 10 before they could remember everything)!

That pendulum also needs to swing to your partner, if you have one. Finding a babysitter was a total game changer for us, but we try and have once evening a week where sit and do something together even if it is only to watch a film sans phone! However, I also needed to learn to let my partner take some of the mental/ home care load. This involved me having to let go of some things (my control over every aspect of the home and kids and perfectionist ideals) and let my partner support me. Initially he needed help and understanding as he took on roles I had always assumed. The first time he did the online food shop we ended up with more beetroot than anyone could ever need, but only 5 main meals for the week! But I needed to remember to give him space to learn his own way (which was perfectly valid – even though it was not that way I would have done it) and the credit of being a fully functioning human adult!

Then last on the list (but definitely not least) is you – it is a cliché but you must refill your cup every so often so that you have something to give. It is important to find time to exercise even if it just walking in the fresh air (you will feel and sleep better), enjoy your hobbies or just relax. See my post about me time for my peculiar way to justify me time! Maybe I should be examining the need to justify it to myself – but I ‘ll stick that at the end of the to do list and carry on as it is working for me right now!

Mainly I think you must present wherever you are – be a Surgeon at work, a Mum at home and a Wife/Partner when the kids are in bed – be yourself in that magical mystical ‘spare’ time!

’Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?’

I want to write this post to reassure everyone that you don’t need to justify your struggle.

I struggled even though:

– my husband is a star (although the first time he did online shopping we got 7 cucumbers!)

– I have a supportive department

– none of my kids had significant illnesses or other needs

– my mother in law is neither too involved or judgemental

– I am fit and healthy

I struggled largely because my expectations of myself were far to high. I thought I could be the perfect 50’s housewife, the modern helicopter mum and the high performing registrar.

The feminist in me felt that I should be able to do it all just like ‘the boys’ but my guilt fairy was in overdrive. I felt like I had lost myself and was failing at everything.

Although other factors played a part (I’m sure I will pontificate on these in other posts) I mostly just needed to give myself a break.

Therefore if you are struggling for whatever reason it’s ok. We have chosen a path most would not.

If you are a single parent, caring for a parent, being bullied at work, are ill, have children with illness or additional needs or financial issues or whatever else I take my hat off to you.

For anyone struggling for whatever reason it’s ok to struggle. Give yourself a break. Accept the help. I’m here if you need a listening ear send me a message . . .

This is not what you are thinking . . . No trigger warnings required!

My husband and I are talking. He thinks he should read more. I can count on my fingers the number of books he has read since we got married and I can just about still count the years on my fingers too.

I however am an avid reader, in fact we just bought dimming lights, so I am forced to go to sleep once I can no longer see the words on the page/ kindle.

This discussion leads me to confess that I have a problem with the kindle book of the day. I keep buying more and more 99p books at a rate faster than I could ever read them!

He laughs and admits he wandered what I could be buying on amazon with such regularity so cheaply. (He is on it with the financial side of things and regularly reviews our accounts – he could spend everything and I likely wouldn’t realise)

Then he says the words every partner dreads, ‘Actually there is something I should confess to you . . .’a

Heart racing I listen with mounting dread –

‘I’ve been playing the Polish lottery’.

I think I physically sag with relief and express my surprise that as a highly logical engineer and spreadsheet specialist, who keeps such a close eye on our finances he would ever buy in to the stupid tax. However, he proudly reassures me that after his extensive research – the Polish lottery has the best odds!

I know this is a silly little story, but I love that these little surprises turn up after all these years.

This is my beautiful daughter. She was born as COVID struck the UK, we left hospital on Thursday and my son had a fever the following night and so we went into self isolation and the country locked down before we were finished isolating. At least my husband got to be there for the birth and my parents saw her. She was 4 months old before the rest of the family got to meet her.

I think the worst thing to happen was the announcement of the closure of schools and nursery’s on MY BIRTHDAY!! I appreciate this is not the same as being on the frontline in full PPE, but I was very hormonal. I needed a grieving period for the maternity leave I had so been looking forward to – coffee dates and sofa feeding with box sets (studying for my diploma).

The initial weeks of my little girls life were marred with anxiety about whether I would have to leave my little squish to go and man a ventilator, but also about how on earth I would manage with 3 kids I genuinely believed it was not possible. Thankfully we have now survived 2 lockdowns without me having to learn anything about respiratory, although I have learned a whole new respect for teachers!

I have therefore been a stay at home mum to all 3 of my kids – which is not a situation I would have ever signed up for. But you know what, despite the times where it was undeniably awful and stressful – there were more than a few ugly tears, but it was a whole lot of fun and I feel so much closer to my kids. I even got school star of the week, oops I mean my son did 😉 , for our video of him metamorphasising from a tadpole to a frog! But as schools are back and my middle one starts nursery again this week so I am free for a precious 2.5hrs to adore my baby girl (and I might even think about that diploma – if she ever sleeps)!

The weird thing was I actually had a strange FOMO about COVID. I thought in years to come people might ask me about it and I would have to admit I was safe at home. Now I know COVID will be waiting for me when I get back – I think I’m going to take a full year off this time to get some coffee dates in though!

Having your own interests and maintaining a sense of self is so important. The common platitude of looking after yourself in order to be able to look after others is often touted, but often not given much more than word service. Finding the time and energy to invest in your own pursuits is daunting.

To some (all?) what I am about to say might seem like the fun police have rocked into town, but this has helped me sooo much and after all isn’t the point of this blog to espouse my own hard won gains in order to maybe help someone else . . .

So my life changing advice is to make a to do list of things you like to do! I made a 40 for 40 list (still 3 years and a little more than 3 weeks away).

This includes the big ticket travel items and once in a lifetime experiences, but mostly I wrote things that I want to do, but never prioritise.

• Read 40 books
• Watch 40 classic films
• Learn 40 baking techniques i might need on GBBO (never applying!)
• Cook 40 new recipes
• Complete 20 craft projects
• Do a sprint triathlon
• Go to a Chinese supermarket
• Do 40 spins of a hula hoop
• Grow a vegetable
• Make a piece of jewellery
• Throw a pot
• Go camping as a family

For me this has helped me to legitimise my ME time. This may detract from it for some. But now if I sit down to watch a film or lie in the bath to read a book I am actively working towards achieving a goal, MY goals for ME – instead of stressing about what else I should be doing to achieve my work or family goals instead.

And to me there is very little else in life that trumps the pleasure of crossing something off a to do list!

I have struggled with confidence and the one thing i found woefully lacking was practical advice on how to be more confident . . .

Trainer: ‘Be more self-confident!’

Me: ‘Ok how?’

Trainer: *blank look and uncomfortable squirming*

So what is confidence and what affects it.

My wordy definition – ‘Confidence is a self-belief drawn from an accurate appraisal of our knowledge and skills and our ability to portray this through our actions.’ Being confident requires having a realistic sense of one’s capabilities and feeling secure in that knowledge.

It is pretty much normal to not feel quite comfortable in many situations we may find ourselves in. This is imposter syndrome and almost everyone I have spoken to suffers with this. It boils down to that ubiquitous sense of ‘winging it’ and fear of ‘being found out’. This can spur us on to better ourselves, but is an issue when it causes us to become frozen in self-doubt.

So a pre-requesit of having an appropriate level of confidence is having the skills and knowledge required. (Yet another planned post will focus on tips for studying!)

If a trainer is telling you to be more self-confident then this translates as – ‘Your perception is not a true reflection of your skill and knowledge’ and this means you are being overly negative. If you are too positive then you become arrogant and cocky!

Self-Confidence is our own perception, which is based on our own thought patterns. External factors such as illness, changing circumstances, bullying or domestic abuse can also have a massive impact. If this is you, seek help. I needed counselling after suffering mental health issues after the birth of my first child.

So to improve confidence we need to challenge our perception of ourselves and ultimately change our thought patterns. There are two ways to challenge your perception. You can seek extrinsic reassurance or you can promote intrinsic change.

Extrinsic reassurance is definitely the easier to come by although people suffering from low self-confidence tend to shy away from it for fear it will confirm as oppose to quash their insecurities.

The single best external reassurance i have found was hearing things I wasn’t supposed to (namely whilst hiding behind a door crying). But more practically you can ask for feedback and loads of it – you are better than you think.

Secondarily learn with your peers. In all likelihood they are no better than you and may be suffering the same insecurities. Attendance at a BOA instructional course taught me two things

1) My expectation of what I needed to know was far too high

2) I was actually performing at the same level as everyone else

To increase confidence for procedures ask the consultants to walk through things before cases and debrief after so you know what is expected and how you compared to that.

Intrinsic change is more difficult to come across and may involve a long dark night of the soul. Although this is an excellent TED talk on faking it:

Fake it ’til you become it: Amy Cuddy’s power poses, visualized

So this comes back to our thoughts and trainees who suffer from anxiety and low self-confidence are engaging in negative patterns of thinking.

The first step is to recognise the negative thought, then check our perception of events and either challenge the unnecessarily negative thoughts or change our future behaviour accordingly – you may recognise this process as reflective practice, but many of us do this fairly superfcially!

First I write down the events from my emotional brain (Katrina Ubell’s thought download). I encourage myself to be as emotional and true to my feelings as possible at this point. Then after some time (very variable). I review from a more rational place and identify negative thought patterns. Then I challenge these thoughts and choose better ones – easy huh! I’m a stationery lover so I have a specific notebook for this and coloured pens to add my reflective observations when I look back.

Initially you may need a trusted mentor or friend to help you challenge this view of yourself. Although I would recommend an initial edit alone as I would often come across as slightly unhinged if I let anyone read the first version!

Some personal examples of my negative thought patterns. . .

Boss texts to say ‘can you pop in to see me?’ I immediately think I have fucked up the procedure. I did alone over the weekend and catastrophise all the way to work – ‘I’m in so much trouble’, ‘what if their arm has fallen off or they are dead!’. In fact he just wanted me to pass on a message to someone!

I’m doing my second hip replacement and it is not perfect. Deride myself until the boss dispels my unrealistic expectations.

Difficult trauma case with multiple medical complications. Blamed myself for not being able to care for this patient alone. Consultant pointed out that I am not trained in intensive, renal or respiratory medicine and as such I should not be expected to manage complex conditions pertaining to these specialities.

As you can see in each of these cases I needed the external validation of the consultant to adequately challenge my negative thoughts, but to get this I had be brave and talk to them.

Finally we also engage in negative bias believing the one bad comment, amongst all the good. Research has shown that thinking about 3 good things that we bought about that day before we go to sleep every night for 2 weeks is as effective as a 6 month course of antidepressants. This you tube video is excellent https://m.youtube.com/watch?v=hZ4aT_RVHCs

By changing my thoughts, I change the way I feel and voila – a growing sense of confidence. This is very much a work in progress and I suspect something I will need to do forever more. But i am now at the point where I happily volunteered to do my first unsupervised humeral shaft fixation , rather than being terrified at the prospect of a carpal tunnel decompression when I already had more than 50 under my belt.

There are great resources for more information about negative thought process and access to online CBT resources. See the Useful links page.

Today I went to float in the pool. At 7 months pregnant with another giant child I like swimming. Most specifically the moment when the water takes the weight of the bump and the sweet relief of release of the pressure from my of body. It got me thinking to how we rarely take the pressure of our mind and the pressure of thoughts.

The way we think shapes so much about us, but we rarely consciously think about it (how meta is that!). Once again this process started with my body not my mind when I started to listen to Dr Katrina Ubell’s postcasts about weight loss. To listen go here https://katrinaubellmd.com, but in brief summary.

Events and circumstances are neutral.

The way we think about these neutral events shapes our feelings.

We can choose the way we think and thus the way we feel.

So today my starting feeling was annoyed. I was tidying the house, again, on my day off. I received a work email that stamped all over a lot of work I had done, at a detriment to my trainee colleagues. Then my friend cancelled a long awaited catch up because she was too hungover.

I was working myself into a foul mood and was so tempted to send an angry email and a biting reply to my friend. I called my sister to rant. She dutifully listened and then simply said ‘Do you want to stay friends?’

This got me thinking that of course I didn’t want to hurt my friend, but my feelings were hurting!! Then I remembered I get to choose – so instead I chose to feel thankful that my friend felt so secure in our friendship that she could be open with me and admit her mistake, rather than struggling though out of sense of duty.

It changed my whole day.

Our thoughts can be so toxic and all to often I hear my friends and fellow trainees putting themselves down and engaging in negative thought processes. All this can do is bring us down and the next blog post about confidence will contain practical advice on tackling this.

Perhaps its time we dedicate some time to our thoughts. Although I have to admit I’m still struggling to be anything but annoyed about that work email . . .

I got my husband the Hidden Chimp Book from DS1 for Christmas. We were reading it together as a family and found it a great way to talk to him about behaviour. Until that is he used it against me . . .

The book allows your child to name their inner chimp, my DS1’s chimp is aroomalacka and mine is Juno. This is so you can talk about the chimp misbehaving and allow them to make a choice between their chimp and themselves.

So far so good, a few tantrums have been headed off at the pass and I am feeling smug.

That is until we are late, DS2 does a huge s*#t in his nappy and my DS1’s inner tortoise has taken over while we are trying to get shoes and jackets on.

We finally get out the door and I’ve strapped the plank champion into his car seat when DS1 decides the transformer he spent 10 minutes picking out is the wrong one. I think I’m doing a grand job holding it together until DS1 looks me straight in the eye and sanctimoniously says ‘Mummy your Juno is out of control, you should teach her to behave!’ 🤯

I’m not proud to say I let her go instead!