Wednesday, May 2, 2012

Guest post: Applying to Residency: Me + Baby, Husband, 3 dogs, 2 cats

In less than one year’s time, I will be embarking on two major life changes: having my first child and beginning residency.

I began medical school single with 2 large dogs and a cat.  People thought this was absurd.  How can you find the time to take care of these animals?  This was simple: my mental health is a priority.  The dogs don’t care if I have a test tomorrow and they certainly don’t care whether I make an A or not.   They have no care for what happens tomorrow or in a year…throw a tennis ball for them, and they have it made!

But my final retort was always: “some students do this successfully with kids; I just have dogs.”  (and you can’t put kids in a crate!)

In the meantime, I met a non-medical man – a writer, a professor and a breath of fresh air from the smog of medical school.  He reminded me of who I was before medical school: I liked to read and write; I liked creativity and conversations.  Long story short, he moved down here and we were engaged and married in a little over a year.

Continuing the quest to balance my personal life and mental health with my medical training, I am going to become a medical student, then resident, with not just 2 dogs and a cat (well, 3 dogs and 2 cats now…I’m an animal lover), but also a husband AND a baby.  Is this absurd?

Once interview season is over I will be back on rotations at the community hospital where I have done my core rotations.  After spending almost a year here, I feel like I have a big hospital family.  Revealing my pregnancy has been met with nothing but enthusiasm.  I feel secure in balancing baby with the last of my rotations here.  But before I can take that deep breath…I have to take boards, go on away rotations, apply for residencies, HAVE A BABY, and after my maternity leave, go on interviews…and hopefully match!

First, I debate over how open I should be with programs about having a baby.  During one of my audition rotations, I will be noticeably pregnant.  I suppose this is a good litmus test for the family friendliness of the program.  However, by the time I am on interviews, I will be at least 6 weeks past delivery and will not necessarily have to disclose that I recently had a baby.  Of course, depending on the length of the interview day, I may need to pump!  Perhaps I need to be confident that I can be a mother and a good resident and thus be open to programs.  But this is the problem: will I be a good mother and resident?  Or are these two things going to be mutually exclusive?

I am also debating where to apply and concurrently having the ultimate debate over what I want to be when I grow up.  Fortunately the debate has been limited to psychiatry versus neurology or perhaps both? And has been limited to such parameters since undergrad, maybe before.  I now wonder what's going to change when this little boy arrives?  How am I supposed to know who I'll be 5 months from now let alone 5 years?

My thoughts race from one obsession to another.   Neurology vs psychiatry, neurology vs psychiatry, neurology vs psychiatry.  Graco vs Chicco.  Graco vs. Chicco.  And boards!  Oh no!  Last night I had one of those ugly recurring medical student dreams of nephritic versus nephrotic disorders...

Sometimes I feel like my head will explode. 

I’ve concluded it is easier to just make decisions.  There is no way to determine the perfect decision, and I imagine that there is, in fact, no “perfect” decision.  I decided to go for neurology.  I am intimidated by the work hours, the larger hospitals and the fact that there are no programs in my hometown where my mother could help with our baby.  But I don’t want to live my life afraid of a challenge.  Besides, I probably haven’t said enough to explain that I have the most supportive husband.  He’s even willing to put my career ahead of his (yet again) to be a stay at home dad.

Life is scary and thoroughly exciting, and these feelings are never mutually exclusive.

And I really have no idea what I am getting myself into…

"Emmylee"

22 comments:

  1. I did have a baby and supportive stay at home family member when I was a resident. But I still cannot put any animals into that mix. Sounds like you are overwhelmed already. Is supportive accepting husbund enough for your "mental health"? I remeber treasuring minutes (!) I could spend with my child before child's bedtime. Because if you are lucky to be home for the night, it is your child's bedtime already. I guess I just never understood people who cannot balance their life without being on the verge of emotional disaster and then they tell you they have 3,4,5... animals. Good luck to you. Somehow I feel you will be a very good psychiatrist.

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  2. Although I take some issue with Anon's tone, she does have a good point: having a supportive husband may not be enough help. I'm doing the PhD phase of my MD-PhD, and just had a baby (and have a dog), and I can tell you that having a supportive husband is *barely* enough. I'm only working 8 hours per day right now while my husband is out of the house for 12 hours on a good day, and we have it WAY easier than most families who are doing residency + baby. Not to scare you or anything, but this whole transition to becoming a mom-physician-scientist has been a lot more challenging than I expected. Just be prepared, and if possible have back up help for your husband, because he may end up feeling very isolated with you at work 80 hours per week. Maybe hire a dog walker? At least?

    The whole not seeing your kids every day (or potentially all week) was also not something we'd really thought about pre-kid. My husband is in this situation, and it's been harder on him than he thought it would be. I suspect it's the kind of thing that's harder on the parent than the kid, but don't underestimate it. Feeling guilty and being sleep deprived can mess with your head and make you miserable. Not sure if you really can be prepared for it, but maybe knowing you won't be alone will help some.

    Good luck! And don't rule out psychiatry!

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  3. Sorry, the second anon comment was me -- forgot to sign in!

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  4. OMDG - I am the first Anon above. I did not say having one animal was anything unusual. Just juggling multiple animals, newborn and medical training - that is hard to understand for me. Luckily for the poster her husbund will be SAHD. My post did not have agenda for certain tone, but one personal opinion.

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  5. Anon -- I completely agree with you. I sometimes feel like I can barely manage the baby + the dog + grad school, and recall the days when we thought about getting a second dog with amusement. How the heck would I have handled that! Let alone *three* dogs and two cats.

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  6. You don't sound overwhelmed. Just anxious over the upcoming changes, and appropriately so. I think a lot will boil down to how competitive you are in neurology. Matching somewhere in a smaller city where you can afford a decent yard and where your husband can make friends would be HUGE.

    The above posters bring up *very* good points, but with that being said, you need to do what you love in the end (as long as you factor in the other things you love, i.e. family time, into the specialty selection equation).

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  7. Hi Emmylee,

    Congratulations on the upcoming interviews. It will be a new chapter in life. I've just made a transition from med student to resident and have just had a child after the first year and a half of residency. While I think every residency program is different, and every family dynamic is also different, I thought I'd share some advice that I have recieved from resident mom friends who have stay at home partners and also resident friends on the selection committee.

    I would say the general discussion from those on the selection committee would say don't disclose regarding your kids. Everyone has different judgements on how much it will affect you (and trying to convince the senior men attendings who had stay at home wives or even other females from a different time and dynamic (check out Dr Sibert's New York times Don't Quit this Day Job article http://www.nytimes.com/2011/06/12/opinion/12sibert.html?pagewanted=all)is not something you want to waste the interview time discussing. If you get asked, they would recommend presenting that you have a good plan with a stay at home dad (and would leave out the pet discussion unless you get asked about that). As one colleague told me - in terms of personal things it is much better to "keep an air of mystery" and it is one of the reasons psychiatry residents are asked to maintain boundaries with their patients and not disclose whether they are married etc because it colours what people think of you (even though it shouldn't).

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  8. The guys in my program say they don't discuss their personal life and even if they did mention they had kids it's said with a look how I'm on top of everything tone. One close guy friend (on the selection committee) mentioned that the problem with some women candidates is that they always want to discuss their personal lives which "aren't relevant to their job" and because they have a fine line to play "come off too strong they look like a bitch, come off too weak they look like a damsel", he thinks it's best to play it like a guy "keep personal things personal and private, disclose little when asked, keep an air that all is under control". At the end of the day, our selection committee says their priority is to hire the best candidate who can "do the job" so any time at the interview discussing "personal family" is not an asset. Unless they specifically ask you - at which point what they want to hear is that you have it under control and it won't interfere with your job.

    Once you get the residency/job offer, then you have the ball in your court, and you can make decisions accordingly. If you'd like to find out how family friendly the program is, often the social events where the residents in the programs are attending are best. If someone there is a parent (better yet another mom) it's best to ask what it's like but hopefully you don't run into a Dr Sibert type view so do play it safe. My resident friends who are moms say honestly that it is challenging to work 80 hours a week, and have time with their children, and not see their kids before bedtime many nights a week and that is not counting the weeks where you are working 100 hours a week on challenging rotations, and that is also not counting studying time. Med school is quite different in terms of responsibilities than residents and more is expected of you. Now of course it is possible and everyone has a different journey, and it is worth it, but it can be challenging. Now you may be super smart and capable and learn super fast, which means you won't have to clear your plate for residency, (we all know super learners like that) but most of the residents who are balancing family in my program says it is like running a thriathlon while the rest of the non-family residents are running a marathon, you won't be the best runner because you still have to balance your family. At the end, you have to be good enough, you don't have to be perfect. (Good enough is the new perfect - check out the book if you're interested :-) ) And if you keep an honest litmus on how you're performing, and juggling all duties, it will work out with a very rewarding worthwhile endeavour.

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  9. The thing I wish someone had told me (instead of sugar coating things) is that it can be hard, it can be very hard at times. Those times can require clearing your plate and cutting down to the things that mean most in your life. Only you will be able to decide what is right for you. Don't pick a career/specialty you do not like just because you think the lifestyle will be better - any part of a residency can be challenging and if you like it, you won't resent the time spent studying it. But a kid, a husband, residency, three dogs and two cats may mean that you are running an octathlon, rather than a triathlon (while others are running a marathon), so you may want to try it, but also be flexible to drop something if it's not working out.

    The best advice I got in prep for the residency + family was to book out one night a week for your husband (no kids or anything else) and prioritize that above all else. Our husbands being supportive adults and often our most supportive person in our lives also often get the least priority, and years of time where they are leaned on hard can weaken a marriage. The babysitting money is worth it as our nights where we get to focus just the two of us on each other are one of the things that make the journey one of love and joy. Some of the residents I know have had marriages break-up but those who recommended me this tip find the weekly date night strengthening times.

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  10. Also many have recommended that it IS important where you are having the you time you need - keeping yourself strong and happy is as important so you can play all the other roles you have to play.

    Michelle Au blogs at the underwear drawer and is something I honestly was so glad to read. (Thanks FIZZY) for mentioning her on your posts. There are many great posts but I think the one on it gets better is one that is a useful piece to hearten yourself when the going is tough http://theunderweardrawer.blogspot.ca/2011/03/it-gets-better.html

    Nora Ephron has a piece that is great and I'd quote her here "Whatever those five things [that you describe yourself] are for you today, they won't make the list in ten years -- not that you still won't be some of those things, but they won't be the five most important things about you. Which is one of the most delicious things available to women, and more particularly to women than to men. I think. It's slightly easier for us to shift, to change our minds, to take another path. Yogi Berra, the former New York Yankee who made a specialty of saying things that were famously maladroit, quoted himself at a recent commencement speech he gave. "When you see a fork in the road," he said, "take it." Yes, it's supposed to be a joke, but as someone said in a movie I made, don't laugh this is my life, this is the life many women lead: two paths diverge in a wood, and we get to take them both. It's another of the nicest things about being women; we can do that. Did I say it was hard? Yes, but let me say it again so that none of you can ever say the words, nobody said it was so hard. But it's also incredibly interesting. You are so lucky to have that life as an option."

    She also says: (although I would argue that residency interviews are not the time to challenge things but once in residency, it might, or as an attending)
    " Whatever you choose, however many roads you travel, I hope that you choose not to be a lady. I hope you will find some way to break the rules and make a little trouble out there. And I also hope that you will choose to make some of that trouble on behalf of women. Thank you. Good luck. The first act of your life is over. Welcome to the best years of your lives."

    http://www.wellesley.edu/PublicAffairs/Commencement/1996/speechesnephron.html

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  11. 3 dogs and 2 cats is an octathlon. Imagine an animal or two gets sick, and you need a trip to vet and your baby is fussy, and you live on one very small paycheck, and vet is asking for money upfront. What do you choose to do? Can you do evrything?

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  12. Just wanted to bring in my two cents: psych residency is usually less intense than neuro ( although you already made up your mind on neuro) - meaning especially during internship and first year of the residency itself- that is where you would see the biggest difference works hours wise and stress wise.
    Having child early on is tough but has it's pluses two- for instance newborn will never remember or even register that you were gone for two days when you have to do an overnight call where is 2-3 yo will start asking questions....it's very difficult psychologically to be a new mom and being a new resident because of the amount of responsibilities and guilt that you will have no matter what. But it also forces you to be very organized which is a good thing.
    Not sure if having just a husband as your support system will be enough or not. Especially with the number of animals you guys have to care for. I would say babysitter, dog walker or housekeeper ( if you can afford it) would be a BIG help.
    P.s. Had my baby during internship year and then did 3 years of neurology. PGY2 was the worst.

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  13. its going to be hard. Life just gets harder and more complicated as we get older for sure. I ABSOUTELY want to quit my residency and spend every waking minute with my daughter and have 50 more kids and plan arts and craft for them. I also ABSOLUTELY want to be a surgeon. Both are constantly at odds. I'm still in the lab with only occasional call and its really hard. TRY TO GO SOMEWHERE WHERE YOU HAVE MORE SUPPORT!!!!! This is of ultimate importance. If I could get a hold of my younger self I would tell her this. Its just me and my husband trying to build as much of a support network to help us out. But to be honest, most support systems that aren't your family are EXPENSIVE, and as a resident you will likely be quite broke! All that said, my daughter is the BEST thing that has ever happened to me. Good luck!!!!!!!!!!!! and congrats on your pregnancy.

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  14. Thanks for all the input! I really appreciate the perspectives on dealing with personal matters in a professional setting. For one of my audition rotations my pregnancy will be obvious. It sounds like the best way to handle any questions is with simple answers, not defensive, but pleasant and to the point.

    Isn't it illegal to ask personal questions about family on interviews? Or am I completely naive?

    As for the dogs, I added them into my post to highlight some people's reactions in my personal experience concerning having pets during medical school. Some seem to think having dogs during medical is an impossible feat. And, if people view having dogs during medical school as an impossible feat, then how must they view having children during medical school? And my point is this: having dogs during medical school has not been impossible or even challenging. My furry friends made medical school a more enjoyable experience; they didn't add weight onto my shoulders, they instead relieved the burden by being constant reminders of the importance of living in the moment. My dogs are easy - very well trained and on a schedule. Now, having a baby during medical school won't be easy, but I also refuse to believe that it's impossible!

    So, not worried about the dogs or cats, the occasional hairball or diarrhea. What worries me is 1) the whole process of getting into residency - it's stressful for all of us! 2) SLEEP DEPRIVATION!!! 3) my own personal separation anxiety from baby after he arrives and I must go back to work/interviews, etc, and 4) sleep deprivation...

    I do have an extremely wonderful, dedicated husband, willing to stay at home as long as we need. And, I really appreciate the advice about incorporating a date night and making him a priority as well - this guy deserves some appreciation! He does so much!

    Thanks for all the great thoughts, quotes and links - I will be sure to check them out!

    Emmylee

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  15. And, yes, fingers crossed that I can get into one of my top two choices for residency...where family is just an hour away!


    E

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  16. It is illegal to ask about personal family but people do do it. Some programs are sneaky - Questions like "Who is your favourite person to spend time with in your free time? You have a day off- what are you going to do?"

    Half of the girls I knew took off their wedding rings for interview season and although I thought it was crazy at first - I ended up following suit for programs I really cared about - as it cut out the questions where the programs are trying to suss out how committed you are to medicine. Interesting experience because I then saw how there were no questions about personal life after my ring was off - interviewers talked about research and NGO aid work I'd done instead. With limited interview time, many of us who did take off our rings felt that it helped us match to our first picks. Of course this is a small sample size experience and anecdotal - would probably ask others what their experience is.

    Many people think - I'm good enough, I don't need to change anything about myself and I'll tell them all about me, and my family - but honestly my selection committee buddy says that their job is to find the resident most committed to do the job well. When it comes down to selecting the best candidate, if you spent your interview discussing how you can be an asset to their program, rather than other roles you will be playing e.g. mom, wife etc etc, when the committee meets - you are the candidate that sticks out in their head for the cool things you've done. Keep in mind this advice comes from a guy friend on the committee so women may have a different perspective, but in the end, he told me, if you want to have a level playing field with the guys and other people, then present yourself with a level playing field and avoid questions. While it is an asset for a man to have a wife and kids (hence they don't take off their rings), more often than not it can still be the wrong message for interviewers who are concerned about call coverage etc. There is always plenty of time to let people know you're married and have kids at the orientation social after you get into the program.

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  17. Congratulations on all of the exciting changes in your life! I am new to this blog- but your story was so similar to mine, I thought I would chime in.

    I had my daughter in October of 4th year, and started the interview trail for Radiology 7 weeks later. I also was concerned about discussing the fact that I was a new mom- and I am not sure there is any one correct answer to this question. Radiology is still a very male dominated field, however I felt for me the only way to truly see if I would fit in with a program was to be honest about my entire life- kid, husband, career aspirations, the whole story. I felt that if they wouldn't match me because I was a mom, then that is a program I didn't want to be tied to for the next 5 years of my life. Remember, this is a huge commitment, and you need to feel like you fit in, and that you will be supported both academically and personally both by your fellow residents and attendings. For me, it was important to know that I would be accepted for the whole me. Several years later I was on our residency selection committee which gave me a different perspective of the selection process. This is only one person's experience, and one selection committee- but the discussion of female applicants being or becoming mothers never came up- and believe me- this was a male dominated group.

    I was very happy to match into my top program, and they were more than supportive when I was pregnant with my son during my PGY 3 year.

    As for having kids and residency- everyone on here will tell you it is hard- and I agree- there is no way around that. However, it sounds like you have the perfect situation for success. I never could have done this without an amazingly supportive and understanding husband who has been more than willing to pick up the slack when I am on call...post call...studying for boards, etc.. As a mom, it is hard to accept that you are not always the primary care giver- but I knew that going into medicine. I chose to have a career, and I chose to have these kids with my husband, so I have accepted that I won't always be the primary care giver. Accepting and understanding what that means has been important so I don't constantly feel guilty about not being home as often as my other mom friends are who are not in medicine.

    As for career choice- choose what will make you most happy for the next 30 years of your career. If you choose something just because it is an easier residency, you might not be happy, and then what message are you sending to your kids? If you think you would be equally happy- then maybe consider the residency committment also.

    By the way- I also had 1 large dog, and 2 cats- and graduate from residency next month.

    Good luck!

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  18. Good luck with everything. I am a mom of older kids and a 4th year mee student for a few more weeks. Lots of the comments have been really informative, so I'm just going to fill in sme extra stuff from my specific experience.

    I did not match. I wrote about my kids in my personal statement when I applied for residency. I also thought I wanted to know a residency would be family friendly up front. I was also, obviously, very open about my kids in my interviews. I cannot say if that was why I didn't match, but I am not going to do either during the next interview season. Your mileage may vary, of course. But that's very little consolation if you don't match.

    Also, if you are pumping, (which I did for both of my kids and I think is awesome!) you will almost definitely have to pump during most interview days. The interviews I went on generally began at 7 am or so, and usually ran until mid afternoon. Either you will have to say that's what you're doing, or make an excuse to disappear for a good 20 minutes or so, which may be hard since most programs plan out every minute, or be painfully engorged. And, pumps are large and pretty obvious looking, sothat will be kind of hard to hide.

    I have a dog and two cats, and they are really quite a minor concern compared to a child. I thought being a pet owner was a big deal before I had a baby. Sorry to your pets, but they will most likely become much lower on your list of priorities.

    Anyway, good luck with everything. I know some of this is contradictory (hide it! pump!) but I'm just trying to give you info from my experience so you can make some informed choices.

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  19. Sorry about the typos, I'm using a mobile device.

    I am a 4th year *med student and I wanted to fill in *some extra stuff.

    By the way, one of my ancient cats woke up me up at about five a.m. I'm done with my rotations and am treasuring a relatively normal sleep schedule, and being able to spend time with the kids, take them to school, etc. After trying unsuccessfully to ignore her, then scold her into stopping meowing, I finally gave in and fed her so I could hopefully get some more sleep before my alarm went off. A few minutes later, there was more howling. Apparently the dog came and ate her food. Those stinking animals are lucky I'm a pacifist or else we'd be a one pet household at this point, because I wanted to kill them both.

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  20. You have it made. You have a stay at home husband! Your life is going to be a cakewalk compared to most physicians with children...I'm married to a resident, and I'm a soon to be resident. We had our child during medical school and it was brutal. BUT my husband worked 80+ hours a week, as did I, because we were BOTH med students. A stay at home dad and you as a neuro resident? Beyond doable. I have a friend in the same specialty, also with a PhD husband who's staying home. Their lives are infinitely easier than my family's.

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  21. I was pregnant when I submitted my ERAS application. I included "I have taken time off to devote to my newborn son." During interview season, I had to pump. Per my Clerkship Director's advice, I called all of my interviews beforehand to inquire about pumping facilities. Disclaimer: I applied to/ matched Pediatrics (and got my top choice). Everyone was soo helpful! Most of the Attendings who saw me with my inconspicuous Medela pumping bag commented "oh, I remember pumping during residency/fellowship interviews!" with a smile on their faces.

    I agree, I was nervous about mentioning it, but in the end it worked out perfectly. The programs I interviewed with were all very nursing-friendly, an indicator of being baby/ family-friendly. Might as well be upfront from the beginning.

    Best wishes!!! Nursing is the best. Pumping sucks, LOL.

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  22. Congratulations!

    I don't know if I would call kids and Med school/ Residency a cake walk no matter what your husband is willing to do. I do, however, think that there are things that make it more reasonable like living close to family, having a husband who is "in it", and really liking your specialty choice.

    The timing of my second child sounds similar to what yours will be. I got married in the first few months of med school, had my first child between first and second year and my second child in October of my fourth year without taking extra time off from medical school. I am entering Residency (at my first choice program) in little over a month. Its busy but doable.

    I can't speak to how having kids in Residency will be, because I have yet to find out for myself. But pregnant during boards: Bathroom breaks are crucial. And pregnant during audition rotations: Work your hardest, they will appreciate that you are not asking for slack because of the pregnancy. 4-6 weeks postpartum on interviews: I was open about my family and that I wanted to stay in a certain area because of them. It seemed to have advantages- I was a safe bet because they knew that I was not interested in bigger name programs farther away. I think that legally they are only allowed to ask about family/children if you bring it up first. Also, I only pumped on one interview where it was convenient. Others, I pumped in the car before and after interview day. Just be prepared either way. Tylenol or Motrin help with the discomfort of engorgement if you have to go longer than usual without pumping.
    Specialty: choose the one that has the most bang for the buck- residency options closest to support network, reasonable lifestyle, and you like it.

    Best of luck!

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