Tuesday, January 31, 2012

yet another posting on career vs. family

A few months ago I was having a not-so-great day on the Transplant service. The not-so-great aspect of this day had been brought about by the need to discharge a single patient after his allogeneic stem cell transplant. Having to discharge a patient after allo stem cell transplant is both the most mind-numbing and complicated role of the fellow on the BMT service as it can involve the need to coordinate home health, home blood draws, line care, monitoring of drug levels, home antibiotics, home TPN, outpatient medication, PT/OT equipment, transportation, clinic follow up, and a lot of patient teaching.  In fact, no discharge would be complete without an irate call from the discharge planner about some order I entered incorrectly.

While although important, this isn't very satisfying work and I was already a tad annoyed by some of the inevitable “complications” that had arose. I was trying to hide this annoyance and get through attending rounds quickly when my attending turned to me and mentioned that there was a grant proposal meeting regarding a clinical trial our institution was trying to get off the ground. It was this afternoon and I should definitely go.

My annoyance deepened.  Oh sure Dr. Attending. With about ten thousand little BS issues I have to resolve in the next two hours, I definitely want to go to your grant proposal meeting. Wonderful.

He mentioned the trial would involve the use of autogenetic stem cell transplant in patients with HIV-related recurrent lymphoma with the goal of curing the recurrent lymphoma and eradicating the HIV.

Now he had my attention.

Although I complain about the fellow’s role on the BMT service, I actually find transplant fascinating and have considered extending my fellowship for additional BMT training.  And while it might sound strange, I also find HIV fascinating and for a brief period considered ID just so that I could study and treat HIV (the fact that all the ID peeps I know get to do some wild traveling might have contributed to my interest).

A corner of medicine that involved both? Here, at our institution? I was definitely interested.

The meeting was between the clinical transplant staff and the basic science team. It started with the members of the lab explaining each step in the development of the vector carrying the gene for HIV resistance and how it would be introduced into the patient’s stem cells. I don’t want to embarrass myself by pretending I could follow all of the molecular biology, but followed enough to become very excited by this project that bore more resemblance to science fiction than any clinical experience I had ever had.  My attending then took over and explained what they proposed would happen to the patients who received the genetically modified stem cells.

I’ve worked on a lot of dead-end and/or boring research projects. In fact, I’ve never been part of a project that really piqued my curiosity, although some have been better than others. I had certainly never felt as excited by any project as I was sitting in that dark conference room.

I wanted in. I wouldn’t care what menial task it was, although I did start to envision what it would be like to write the first manuscript of a paper on curative HIV therapy.

My unborn son thumped me and reality set in. It is not a bad reality, but it is this – I almost certainly not staying at my current institution when I am done with training, and this project is still years away from inception. This is not because I don’t want to stay– and sitting in that room I really wanted to – but because we need to move closer to family when I am done here. I am actually very fortunate in that, my husband, who has followed me three times during my training, wants to move to the town in which I grew up and I have promised both him and my family that we will relocate as soon as I complete my fellowship.

I have also already decided against additional BMT fellowship training, which would almost certainly be required of any MD who wanted to be a part of this project. I have multiple reasons for this decision, including the need for a job with regular hours (please!), the need to start paying back my loans, the obvious financial needs of our expanding family, and again, the need to relocate. I like transplant, but I don’t feel as though it is something I absolutely have to do in order to feel intellectually and professionally satisfied. 

But I can’t pretend part of me doesn’t want to go after this. After all, I started med school when I was almost 22, I am now 31, so what is just a few more years of bad hours and worse pay for the chance (and it is really just a chance…) to be a part of something huge?  Maybe this isn’t the time – after I have almost a decade invested in my training- to start passing up opportunities.  

But that wistful, sometimes nagging, line of thinking hasn’t dominated my decision-making and, at least right now, I am very comfortable with the current plan as it is in place. 

This has become a much much longer post than I had intended and I worry I might have lost some of you along the way. This is unfortunate because part of my reason for posting it is to get feedback from those of you who have faced similar decisions. To be clear, I really don’t think I will regret the decision to move and forgo the very remote possibility of being part of this project, but it is the idea of slamming doors now, so early in my career, that is unsettling.



  1. A friend told me about a talk she went to by Deborah German a few months back. Below is her profile:


    The talk was about making decisions for her family that ultimately ended up working out for her career as well. I think it's a valuable lesson. You don't have to take the obvious path to end up with a satisfying and successful career, and sometimes your family needs to take priority -- and that's ok too. Just because you put one career aspiration aside does not mean that another one will never open up again.

  2. I read this quote in a paper somewhere, and I makes me feel better when I worry about big decisions:

    To evolve is to surrender choices; to move forward is to accumulate all the things we can no longer be.

    Maybe it's cheesy, and not actually substantive, but for some reason, it speaks to me.

  3. You can have anything you want, but you can't have everything you want.

    There's no reason you couldn't extend your training (an extra year or two is nothing in the grand scheme of things). There's also no reason you have to, and it sounds like you have a great plan already.

    You could take this experience and look for opportunities to fulfill the same kind of interests when you get to your planned destination. Now you have more information about what would hold your interest in the long run.

  4. i did not do a fellowship because of my little 2 year old son. now i am earning a decent paycheck, am my own boss with great hours, and have time for both my husband and son. i thought i would have regrets after doing academia track so long but now i am so glad that i put family first. life is too short and time with your family too precious. i understand your decision as i was always on the fellowship track and pulled myself out of match days before submitting list. good luck!

  5. There is no reason in the world that this academic project must dominate your life now or later. I was very ambicious in my early years, and have better publication record than most attendings that trained me. I left academia for reasons similar to yours and man ! I enjoy my life now. I feel so sorry for colleagues that stayed behind in all the stellar insitutiions where I trained and worked. They are miserable, angry, envious, always rubbing elbows with each other. And I am happy and complete. My kids are thriving (not without my hard work). And I found new fun things to do, like martial arts. Look up this link, even if you do not do martial arts, it should lighten you (all my firends had a huge kick out of it). It reminds me there is so much more fun and joy to life than dry academic environment.
    The Karate Rap 1986http://www.youtube.com/watch?v=LJSZ1TwjcsQ


  6. Speaking from the "other side". I chose to close those doors and while I don't regret it EVERY day. Now that my son is grown, I have very deep regrets. Take a couple of more years...be really, really sure that the move is worth it.
    Mine wasn't.

  7. My friend told my last year she never looks back, only forward. And even though I was doing the same most of the time, I realized later how wise that is. What's the point of looking back and think/regret"what if"? you never would know where you would be "if". I spoke to a guy from top academic center whose research took 1 place at that national meeting we were attending. He was whining that all his friends who are not in academics are happier and wealthier, and he wishes he DID NOT stay in academia. Well,it came from the most successful (at least for his age) academician.

    My take on that - do not regret, move forward. Life could have been far worse if you did not "close those doors" i see more unhappy academicians than non-academicians.


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