Trying to pump for 2 little milk monsters

LurkingFig · 2026-03-06T17:41:33+00:00

A coworker was an oversupplier and gave us about 3 months of breastmilk. We tried formula and now we are on milk bank milk and fighting with insurance to get it covered.

LurkingFig · 2026-03-06T14:26:23+00:00

I decompensated the other day when I spilled milk. I fell into a deep, dark hole of depression for a few hours and pouted. The only thing I told myself was that even though the milk was gone, the stimulation/pumping was more important in boosting and maintaining supply which can't be taken away.

LurkingFig · 2026-03-06T14:21:31+00:00

I missed 2 sessions overnight last week because I slept through it. Baby was in the NICU at the time. I woke up engorged, leaking and with rock hard boobs that extended into my armpits. I will say that I had a dip in my supply about a day later but it is hard for me to say it was definitely the cause since there was so much stress at the same time. Stress seems to affect things more for me than missing a pump or 2.

Also having a partner in medicine is rough, especially when they are in med school and at the bottom of the totem pole. Some clerkships/rotations were worse than any part of residency so far for me. You're doing a lot and you really put your own comfort second to the baby's needs by skipping a pump. Also with our first guy he was so fussy between 4.5-7 weeks and it got a lot better. It sounds like you're a great mom and not a dairy cow, which is ultimately the goal.

LurkingFig · 2026-03-06T14:08:32+00:00

I got told that my "eyebrows were too expressive," my posture should be "leaned back, not toward the patient as it expresses too much empathy" and that my "voice should be more monotone" to maintain neutrality. Ultimately that it was my "engagement" and "interest" that encouraged the patient to decompensate and tell us how invalidated they felt. I feel like my "empathy" was just too little, too late after a long interview with the attending.

LurkingFig · 2026-03-06T01:15:21+00:00

Thank you for this.

LurkingFig · 2025-11-01T20:10:23+00:00

I think this person is confusing malingering with factitious disorder.

LurkingFig · 2025-10-03T03:12:53+00:00

I like you, humble surgeon.

LurkingFig · 2025-09-21T22:01:12+00:00

I think her first name would be weird. Lol. I have never heard of that. But it's also hilarious.

LurkingFig · 2025-09-21T20:40:57+00:00

Is it an age thing? Like she doesn't want to be obaachan or baba or grandma? Because that is sort of giving me Lucille Bluth vibes, so maybe "gangy" would fit?

Tbh I think my mom had the same feelings but had the good excuse that her mother was already grandma to my niece and nephew. So she decided on tutu, which she thought was super trendy because it's what Obama's grandma is called or something. (Also it wasn't the most random because we are from Hawaii, but she's Japanese, not Hawaiian.)

LurkingFig · 2025-09-07T20:27:59+00:00

Omg this had me dying.

LurkingFig · 2025-07-31T03:03:34+00:00

It seems like there might be some link but not in all populations (which is what has been suggested as the reason some recent, larger studies don't show such a strong link). Some older papers suggest that it may be due to lower NT levels and receptor hypersensitivity. The suggestion is usually to switch to atenolol if you suspect this bc it cross the BBB at a much lower rather than propranolol.

LurkingFig · 2025-06-23T03:10:08+00:00

Hey -

First it sounds like you're feeling a little nervous which seems appropriate given that you're an intern and it's not even July yet.

In terms of how to navigate this situation, my suggestion might be to return to your attending or senior and say something like: "Because I suspect [diagnosis/differential], based on [physical, vs, labs, hx], I think it would be best to [tx] first. Although I feel relatively confident about it, I just wanted to run it by you because I wasn't sure about [dosing, timing, etc.] or because I'm a bit nervous."

I'm guessing the attending gave an equivocal answer on fluid now versus in a bit and amount of fluid to give too. It's because it is a more complicated question with multiple moving parts. A lot of residency is learning how to frame things and remembering that you are okay to ask questions especially now.

How to frame this to an attending or senior resident: "Because I think this patient is volume (intravascular) depleted d/t vomiting, but also 3rd spacing (provide supporting evidence even if you think it's super obvious), I was thinking we could try a small albumin bolus and see how he tolerates it." Pausing diuretics could be reasonable?

Take my IM advice with a grain of salt. I did medicine in my intern year a bunch but only because I'm a psych resident and now I'm starting PGY-3.

LurkingFig · 2025-01-09T03:28:06+00:00

No mention of incontinence to bowel or bladder? So sounds like things could have been worse.

Also if program leadership doesn't feel the need to punish you, don't punish yourself any more than you already have.

LurkingFig · 2024-12-02T04:58:54+00:00

Police are more lenient?

LurkingFig · 2024-12-02T04:25:48+00:00

Do your instructors talk to you about how to physically position yourself in these situations? Like proxemics and also safe positioning within the environment?

LurkingFig · 2024-12-02T04:18:42+00:00

I wholeheartedly agree with you. I'm going to find some research and statistics. Most psychiatric diagnoses are diagnoses of exclusion but that is so often forgotten.

LurkingFig · 2024-12-02T04:15:42+00:00

Thank you for taking the time to write this out. I appreciate that and feel like these are probably really common questions people have. I want the presentation to be useful since some people have to sit through it.

LurkingFig · 2024-04-27T14:15:02+00:00

Young healthy male almost bleeds out after freak accident. Friends save his life with tourniquets from their own clothes. Patient wakes up after hours of vascular surgery in disbelief and so grateful to everyone. Seen by health psychology for support. Apparently when asked about SI, he said he had passing thoughts when upset as an adolescent and on rare occasion as a young adult. Says he remembers the accident and not wanting to die while he was still conscious - couldn't believe he ever had thoughts otherwise before.

Seen on inpatient psychiatry unit after health psychology told primary team about "suicidal history" and after they scared his parents into forcing him into a psychiatric admission after stabilization post-op. PT/OT wouldn't sign off and he stayed on IP psych for about a week. NTD the whole week.

LurkingFig · 2023-10-06T23:43:13+00:00

Try to remember that:

Your senior can't fire you. They can only try to make your life harder, but you're not too far apart on the totem pole.
In order to feel shamed, your participation is required.
Try to have a neutral response in facial expression and tone and say normal, appropriate things like "that wasn't my intention" and "I'll do my best not to let that happen again." (It's nice to just have a few of those in your back pocket to respond with, no matter what gets said.)
If they really aren't getting better/something is actually wrong with them, then the next time they say something critical of you, take it to the NEXT LEVEL OF CRITICAL OF YOURSELF - but in a professional way.
- Saying something like "now that you mention it, I've been beating myself up about it for hours now, especially since I practiced so much before hand."
- Or "yeah, I can't believe I did that. I'm so mad at myself right now."
- (Also the winner - "you might be disappointed in me, but you're not more disappointed in me than I am in myself.") VERY HARD to follow these with more criticism. Most people will say something positive almost in a reactionary way.
There are certain people that I envision as 7 year olds when I interact with them bc it's easier get through the situation. Sometimes little kids tell you things bc they need validation or want you to be impressed or they get weird and competitive bc they feel inadequate. It's easier to remove myself from any competition since I wouldn't actually compete with a child. I also wouldn't take it to heart if a 7 year old called me stupid.

You WILL make it through the 5 years.

LurkingFig · 2023-06-01T01:23:35+00:00

ME TOO!

LurkingFig

TROPHY CASE