Amazon prepares for the zombie apocalypse

From section 57.10 of the updated service terms for Amazon’s popular AWS service (emphasis mine):

Acceptable Use; Safety-Critical Systems. Your use of the Lumberyard Materials must comply with the AWS Acceptable Use Policy. The Lumberyard Materials are not intended for use with life-critical or safety-critical systems, such as use in operation of medical equipment, automated transportation systems, autonomous vehicles, aircraft or air traffic control, nuclear facilities, manned spacecraft, or military use in connection with live combat. However, this restriction will not apply in the event of the occurrence (certified by the United States Centers for Disease Control or successor body) of a widespread viral infection transmitted via bites or contact with bodily fluids that causes human corpses to reanimate and seek to consume living human flesh, blood, brain or nerve tissue and is likely to result in the fall of organized civilization.

Backing off for creativity

Adam Grant, writing in the NTTimes Sunday Review:

So what does it take to raise a creative child? One study compared the families of children who were rated among the most creative 5 percent in their school system with those who were not unusually creative. The parents of ordinary children had an average of six rules, like specific schedules for homework and bedtime. Parents of highly creative children had an average of fewer than one rule.

Creativity may be hard to nurture, but it’s easy to thwart. By limiting rules, parents encouraged their children to think for themselves. They tended to “place emphasis on moral values, rather than on specific rules,” the Harvard psychologist Teresa Amabile reports.

I always felt bad for my friends with bedtimes.

Relative to typical scientists, Nobel Prize winners are 22 times more likely to perform as actors, dancers or magicians; 12 times more likely to write poetry, plays or novels; seven times more likely to dabble in arts and crafts; and twice as likely to play an instrument or compose music.

“Love is a better teacher than a sense of duty,” [Einstein] said.

Review: Credible for Doctors

Like the ACA healthcare marketplace or Kayak, Credible isn’t actually lender itself. It’s a student loan marketplace of (currently) 9 vendors that allows you to apply to multiple companies simultaneously and compare rates (and terms, monthly payments, total payoffs, etc).

Pros:

  • Polished interface
  • Easy initial application process
  • Ability to compare rates from multiple lenders simultaneously
  • Saves time versus applying to all lenders separately

Cons:

  • Several big players are missing (enumerated here), which means you’d still have to do some separate standalone applications if you want to ensure you’re getting the absolute best rate.
  • Neither of the companies that have refinance programs tailored to residents are included, meaning that Credible isn’t a viable option for most residents yet.
  • Applying through Credible means that you won’t be able to get some of the lender-specific cash-back incentives.

Bottom line:

If you’re a busy attending who has been putting off refinancing because of the hassle, Credible is for you (yes you, I know you’re out there). Several of the big players are included and you can do the preliminary application in minutes and get a rate comparison within a day or two. Once you pick your lender, Credible sends over your application and documents and you’re turfed over to that lender to finalize the process as usual.

If you’re serious about getting the very lowest rate, Credible by itself may not be sufficient. While most lenders have similar rate ranges, you can’t predict who will provide the best, so you’d still have to apply to several of these guys not in the marketplace yourself for thorough comparison shopping. In this case, you could still use Credible to save some time by applying to several lenders together, but then giving up $100-300 referral bonuses in some cases may not be worth it to you.

If you’re still a resident or post-match MS4, Credible isn’t for you (yet). I’m told there are plans for some resident-friendly plans in the future, but the two current players in this arena aren’t part of the marketplace.

 

A Few Lessons from Becoming a Mom in Residency

This is the very first guest post ever on this site, and it comes from none other than my awesome wife. Thanks for your sharing your experiences and insight, honey!

I’m the type of girl who likes to be prepared. Give me a test and I will highlight, notate, and study my anxieties away. Years of pre-med, med school, and residency have solidified this routine and have turned me into a preparation machine. So naturally, when I got pregnant in my 3rd year of residency, I hit the Internet to start studying up.

What to expect? How do I let my program know? How will this affect my patients? My career? What will it be like when I return from maternity leave as a newly minted mom?

I was met with endless blog posts detailing how to make the perfect goody bags for my delivery day nursing staff and hundreds of lists about just how many pairs of socks my little one would need. So like the perpetual student that I have become, I spent many restless nights studying these posts, comparing their merits, and trying to fit all of the information together in a way that made sense in my life.

This helped, in that I was so busy reading, comparing, and consolidating this information in between my busy clinics and residency life that I didn’t really have much time to be anxious about the inevitable changes around the corner.

I suppose it’s no big shock that being pregnant and then being a mom during residency still brought quite a few surprises that I had been unable to prepare for. So many moments that made me wonder, “why didn’t any one tell me about this?” So here it is, a list of things that I wish someone had told me. For preparations’ sake.

Telling your program director

Let’s get this party started. Telling people makes it real, right?

I told my PD that I was pregnant at around 15 weeks. This ended up being good timing because it was early enough that schedule changes and coverage could be arranged but not so early that even speaking to people made me nauseated. Thank you morning sickness.

Good timing aside, there were still some hurdles involved in divulging my growing secret. Medicine is filled with many types of people, including those that say things like “you’re so lucky that you get to have such a long vacation” when referring to the postpartum weeks.

I found that while these remarks made me furious, they were thankfully relatively rare. I’m not sure how to prepare you for the haters except to say that I think that these comments come from people who simply don’t “get it.” And that’s fine. They don’t have to get it. You’ve got bigger things to worry about (see below).

Luckily, my PD was very supportive and excited for me. In fact, he even encouraged me to run for chief resident despite being pregnant (elections fell in my 39th week), explaining that it might be hard at first but if it was something that I wanted to do, it would be something that would ultimately make my time at work more fulfilling. This advice didn’t exactly ring true immediately, especially when I was making schedules just a couple weeks postpartum or coming back a week early to run intern orientation. However, despite these initial bumps, his words ultimately served me well. I have found that while it is incredibly hard to leave my baby to go to work, doing meaningful work that I enjoy makes it a bit easier.

While I don’t suggest that every pregnant resident run for chief, I do think it’s worth mentioning this sentiment: Not all hours of work are created equal, and setting things up in a way that is fulfilling to you, may make it (a little bit) easier to go back to work come the end of maternity leave.

I recently picked up Cheryl Sanberg’s Lean In. In her book, she encourages women to “lean in” to their careers and reach out for leadership positions. I’m still trying to figure out exactly how much I actually want to lean in or out as I apply for post residency jobs, but her perspective was interesting and helped me think about what it actually means to be a working mom and helped me make these decisions. (Ben: she ended up deciding to stay on at our academic institution as faculty)

Note: when I say, “recently picked up” and “book,” I actually mean, I listened to this audiobook on Audible while nursing, pumping, and driving to daycare. (Ben: You can actually get two free audiobooks as part of a free trial membership via that link. Audible seriously changed our lives).

Which brings me to my next topic:

Nursing & Pumping

You would think that a medical degree might have prepared me for this somehow, but it didn’t, which sucked (pun intended).

Did you know that physician moms are more likely to start nursing than the average woman, but also much less likely to make it to 6 months 1. This is kind of weird because the AAP and the WHO recommend nursing for at least a year (and beyond). So why are we more likely to stop than Jane Doe?

There are probably several reasons, but I will say that pumping is pretty tough. In fact, at first it felt impossible. I felt embarrassed when telling attendings that I needed to go pump. When I did, I was actually usually met with support, but often some confusion. “Maybe you can use this closet?”

I have pumped in mail rooms, the copy room, closets…etc. Interesting to say the least, if not particularly pleasant. And with a high likelihood of someone walking in.

Also, I went back to work when my son was 2.5 months old and still nursing frequently, so in order to keep up my supply and be comfortable enough to actually work, I needed to pump several times a day.

Luckily, with time and with the advice of many other physician moms, I learned some tricks of the trade and this all got much easier.

  • If you want to pump, you have to ask. Or rather tell. Most people don’t know what you need. Even if they want to be supportive, they don’t know the logistics of how much time you need and where you can actually pump. So you need to be pretty proactive here. You aren’t doing this for you; you are doing this so that your baby has something to eat. And that’s important.
  • Most hospitals actually have a lactation room for staff, and some even have hospital grade pumps you can use in these rooms. The OB floor nurses usually know where these rooms are so call ahead and you might get lucky. If you’re mostly working outpatient, you may find that pumping in your office while charting is the way to go.
  • Hands free pumping bras are everything. I mean everything. You can pump AND chart or play on Facebook all at once!
  • Pumping can be done in the car (or really most places). I bought a nursing cover and an adapter for my car. This saved lots of time and made me feel super efficient and flexible. Also, several other physician moms have recommended freemies for pumping in the car and even in the OR or during rounds. Apparently they are super discreet, though I haven’t tried them.
  • Things can make your life easier. There are a whole bunch of products on the market designed to make pumping and nursing easier. In my case, I felt like if I could spend a couple bucks and suffer a little less, then I might as well try. So I definitely “tried” a lot of different products. The things that I actually found to be helpful (in addition to those above) were soothies, nursing tanks (which I continue to wear under my clothes every day), boppy, and disposable (and eventually reusable) nursing pads.
  • All in all, while nursing may be natural, it’s not easy. It can definitely be worth it though. Just know you aren’t alone in the initial blahness of it all.

Childbirth & Recovery

Speaking of natural things that aren’t easy…childbirth (AKA another thing that my MD was useless for). Between not wanting to head to the hospital because I wasn’t sure if my contractions were psychosomatic or false labor and knowing what every decel could mean, I would say that maybe that my MD was actually a hindrance.

Interestingly though, it was not really the childbirth part that I found to be the hardest, it was the recovery. I vividly (probably too vividly) remembered the vaginal births and c-sections that I “got to” watch and participate in during med school, and I even remembered seeing several women at their 6 week postpartum appointments. What I did not know is what happens in between those two time points. In fact, I have spoken to several obgyns who said that they were shocked at how little they were prepared for their own post partum recovery.

I will spare you some of the details, but just know that everyone feels like crap during these first few weeks. Whether you are recovering for surgical sites or tears, you’ve got some healing to do (healing down there, discomfort from milk “coming in,” and exhaustion).

Years of residency have taught me to just grin and bear some general discomfort, but in this case I don’t think that is a good lesson. I think this is a good time to be selfish and ask the people who love you to do some stuff for you and help you out. I didn’t do this and deeply regret it. At this point, we are hardwired to try to do things on our own and to prove how strong we are. But then we just hurt ourselves in this case. Healing is much quicker if you allow yourself a little rest. So buy the creams, soothies, gel packs, ice packs, fiber gummies, and spray bottles and definitely take some pain meds. You’ll feel like a human again soon. And if you happen to come across a med student at your 6 week appointment, maybe do her a favor and tell her what you’ve been up to these past few weeks.

Disability & FMLA

At my institution, I was required to file for FMLA through the hospital’s disability insurance company. This was a gigantic hassle. I got multiple emails asking me to let them know the exact date of my delivery in the months leading up to my leave. As I am merely a psychiatrist and not a psychic, this was hard to do beyond providing them with my tentative due date over and over again. Since my due date was on a weekend, this became doubly confusing to the multiple people required to stamp their approval. Even despite this, I still had to spend hours on the phone repeating these same dates to multiple people in order to make sure that my “files” we’re correct. All this chaos and drama was for something that happens literally all the time and really shouldn’t be particularly confusing.

Now as I am applying for my Texas medical license, all of these same forms and dates are resurfacing in order for me to prove that I did indeed have a child and I was not just MIA for two and a half months of residency (Ben: This process also took months as despite her finest efforts, a bunch of forms were still wrong.)

Lessons learned: Make copies of everything,  even if it seems straightforward at first. Be prepared to fill and re-fill out forms and sit on hold.

Depending on your disability insurance, some people can file for temporary disability and get partial pay for their maternity leave. I signed up for the most extensive disability insurance provided by my institution, and I still didn’t qualify (I would have gotten two weeks partial pay for a c-section). You may have better luck if you’ve already purchased on your own separate disability policy. Read the small print in your plan and maybe you’ll get lucky, but if you know you won’t qualify, there’s no point in wasting your time with all the paperwork. I spent countless hours filing disability paperwork after one representative told me I would qualify, only to have the whole thing denied later and a significant part of my postpartum energy expended fruitlessly.

Dealing With Self-Doubt

I recently got some good advice on this matter in an unexpected setting: residency didactics. Our lecturer was discussing the importance of creating secure attachments for babies and then stopped and said something like, “The caveat here is that the mom needs to feel like she’s doing the right thing. Babies can sense that.” He went on to ask if any of us had ever had a baby who didn’t sleep “well” or eat “right,” and whether or not we had ever tried consulting the Internet on these matters. Most of my class had not. I, on the other hand, have already accumulated some serious experience turning to the Internet and returning confused and dejected about my parenting choices. He argued that now more than ever it seems that there is no “right” answer for just about everything that has to do with child-rearing and that the constant barrage of “advice” and seeming perfect Instagram pictures of everyone else “doing it right” has left us all feeling insecure and lost.

He went on to say that one of the most important ideas that he has garnered from the field of child psychiatry is that feeling like you are doing the right thing is the best thing that you can do for your child (as long as what you’re doing is within the limits of safe and reasonable child-raising practices). He pointed out that most babies come out OK despite humongous differences in people’s choices regarding discipline, feeding, sleep training, etc, so long as they feel loved and cared for. A key step in eliciting this feeling is just realizing that you are probably good enough and that you are doing the best that you can.

Help

One of the best things that you can have when trying to raise a baby through whatever you are going through is some kind of help (and in my case a partner). Family is great, but an awesome helpful spouse is a huge part of surviving and enjoying those first few really tough months, both for handling things around the house but also for emotional support. If you have money to spare, other people have sworn by their various hired help, from nannies to house-cleaners and laundry services.

Lastly, here’s  a list of some other random things we bought that made our life easier in taking care of a brand new human:


  1. 98% start in a small study with only 12% making it to a year

The Best Book for the Texas JP Exam

Okay, that title is biased (see below), but here it is: The Texas Medical Jurisprudence Exam: A Concise Review.

When I applied for my license in 2013, I searched for the best way to study for the Texas Medical Jurisprudence Exam and was pretty surprised at the state of affairs (you can read my study recommendations here). There was an expensive $200 online course (i.e. narrated powerpoint) with terrible voice acting and a painfully juvenile script. There were expensive textbooks that cost $100 or more and were hundreds of pages long. And there was one affordable option: a $20 effort with a $3 kindle version that amounted to a long list of facts written in legalese without any attempt at emphasis or context. All of this was for a $58 (then $61) pass/fail test primarily based on common sense that takes less than an hour. You could pass the JP exam with any of them, but none really hit the sweet spot. I left the test thinking that there was a unfilled niche for a study guide that was concise, readable, and reasonably priced.

Then, despite its brevity, it took me two years of intermittently hard work and countless hours to actually write it, fact check it, and publish it.

So, my first “book” is now out:1

 

The Texas Jurisprudenc Exam: A Concise Review

 

My goal in writing this book was to make something that you could read in a single sitting that covered the salient points needed to pass the Texas JP exam while also providing you with a basic understanding of practical jurisprudence for a medical career in the Lone Star State. I’ve opted to sell this ebook exclusively via Amazon’s KDP Select program; in doing so, the Kindle version is included in the “Kindle Unlimited” program. The 30-day Kindle Unlimited trial is free, so if you don’t want to spend any money to read it (or the thousands of other books and audiobooks part of the program), you don’t have to.

As much as is possible given the subject matter, I hope you enjoy it. After you’re done, please review it on Amazon. Your comments and feedback are both welcome and appreciated. Any book of this nature can always get better.


  1. On Kindle, which you can of course read on any electronic device; the print version is forthcoming.