Tuesday, February 19, 2013

MiM Mail: Family/relationship sacrifice

Dear Mothers In Medicine community:

I'm a PGY2 who started off residency last year in an Ob-Gyn program while about 25 weeks pregnant.  While not ideal, I thought I could make this work -- there had been an resident a few years before me who had a baby during the fall of her intern year, and many residents in the program (female dominated) had babies during residency.  My program directors and co-residents were extremely supportive, and I luckily had a very easy pregnancy, healthy baby, and smooth recovery.

While being pregnant was easy, though, going back to work was harder than I had thought.  Many days, I was at work for 14 hours a day, plus I'd work weekends or nightfloat, and this would go on for months at a time.  Despite how much I was working, I hardly violated duty hours and I really did enjoy what I was doing and hardly thought about missing out on things at home because I loved my job.  Meanwhile, my husband was left home alone for most evenings and weekends with a baby, feeling unsupported and exhausted.  He's a wonderful father and in general a helpful, loving husband, but he grew increasingly disgruntled with the situation, and soon we were constantly bickering over my terrible schedule.  Our families, while on the same coast as us, are hours away.  We live in an apartment, so there was no space for a live-in nanny, and our daytime nanny fell through, so our son started daycare (which we all love).  I offered to hire more help for the nights and weekends, but my husband resisted, saying it was unfair to deprive our son of his mother.  Honestly, I think my husband was just feeling overworked, exhausted, unappreciated, and unhappy in his own job, and I actually think he felt that even though I was at work from 5:30 am to 7:30 or 8 pm many days and weekends, my time away from home was actually a "break" from having to take care of a new baby.

Tension at home worsened after I got into a car accident while coming home from nightfloat during the beginning of PGY2.  No one was hurt, but my husband was extremely upset -- not that I damaged the car -- but that I was willing to risk my life for the sake of a "job."  I tried to explain that I loved this job.  I asked about what his expectations were.  I insisted that other people have kids in residency and make it work.  It was all to no avail.  When he basically threatened that our marriage would eventually end and he would seek custody of our baby if this situation continued, I tried to negotiate a part-time position with my residency director, but it wasn't possible.  Long story short, I ended up taking a month off from the program, talking to lots of other people, and then switching into Psychiatry, which is the other field I was considered during 4th year of med school.

My quality of life is much better, but I still feel sad when thinking about this whole ordeal.  I'm adjusting to my new program, and 4 months into it, I feel like I'm getting the hang of things, but I know deep down it's not what I 100% really wanted to do.  And every time I open my inbox and see emails from ACOG, or open my mailbox and find an Ob-Gyn journal, or run into a med student who I worked with as an Ob-Gyn resident and have to explain why they're now seeing me on their Psych rotation (I stayed at the same institution), or run into my former Ob-Gyn attendings or co-residents, or see friends posting on Facebook about how much they loooove their residencies or are doing really cool things, it's like opening the wound all over again -- the hurt, sadness, anger, and embarrassment all come flooding back.  It's especially upsetting to me when I see other female residents, especially surgical ones, who are having their second babies while in training!  I know there must be more going on in their relationships that what meets the eyes, but it makes me sad that other people's husbands must be so much more supportive than mine.

So, I guess I'm writing to ask: has anyone else had to make huge sacrifices (such as switching residencies) in order to save a relationship or pacify a partner?  And if so, how did you handle this?  The resentment towards my husband is fading as I'm beginning to see how wonderful it is to have a life outside of work, but I'm wondering if I'll always feel a little sad about having to make this switch?

Thank you so much for your support and advice,
Anonymous

17 comments:

  1. >>When he basically threatened that our marriage would eventually end and he would seek custody of our baby if this situation continued>>

    My one piece of advice would be NOT to have any more children with this man until you have completed your residency training and are established in practice. If you are otherwise happy in the arrangement as is, great, but adding one or more children at this time seems like a very bad idea. I'd also expect the current situation to degenerate quickly should you decide to return to your OB/GYN residency. The demands of an OB/GYN residency haven't changed, your husband definitely hasn't changed, and you are still married with a small child.

    I don't know your husband, but I wouldn't take those words spoken in anger as an idle threat. A male colleague of mine went through an ugly divorce many years ago. The divorce happened a few years after he'd given up the practice he loved and taken a job working in industry because his wife insisted he was ruining their family life with his long hours and on-call schedule. His wife gained full custody of their child. That probably wouldn't happen in your case, but any divorced parent will tell you shared custody can be a challenge. (Postscript: my colleague's child is now grown, they have a positive relationship, and he returned to the practice he loves with no regrets.)

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  2. What if the divorce eventually happens anyway? There are no guarantees he is going to be happy. Your baby is going to know you are his/her mother and will want a fulfilled, happy parent. I would be bitter if forced like you have been into another field. 5 years from now you may be demanding a divorce.

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  3. I have made professional sacrifices for the sake of the goals my husband & I wanted for our family (they involved relocating and leaving behind a vibrant career & good connections). I had a period of time right after during which I could not talk about the work & career I left behind because it would cause me to break out in tears. I mourned for a long time the life that I would have had. Now, 5+ years later, I am on a wonderful but very different life path that I don't think I would be on if we hadn't moved. I'm pleased with this path but there will always be a small part of my mind that will wonder "what if we hadn't moved?" You might just be in a mourning period for a life path you wish you could have purused. If that is the case, then let the process unfold and be open to the happiness that the new path will afford you. This too shall pass.

    I think an important distinction to make between my scenario and what you described is that even though I sacrificed and hated it, I was an equal partner in this choice. It was more of a "rock and a hard place" sort of choice than an ultimatum held over my head. I think that would make a difference in how the decision would settle into my psyche. You deserve to be supported in your goals. We can't always have everything we want, exactly when and how we want it. Both of these things are true. I'm truly sorry you find yourself in a tough spot. I hope you can find happiness!

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  4. First of all, I am so sorry this has happened to you and your family - the stress of juggling a demanding career, a new baby, and a rocky marriage - is insanely challenging. It's perfectly normal to feel a loss over the "what if's" and "coulda beens" when you undergo a drastic career change, and from an outsider looking into the process of medical training, it doesn't look like that drastic of a change -- you're still a physician, in the end -- but for us, it really feels like a dramatic and sudden change. The pace is different, the medicine is different, everything feels different and maybe not "quite right". And that's what it sometimes must feel like - a sudden and terrible loss. Totally ok to be going thru mild PTSD as a consequence.

    I went through a similar situation, and ended up quitting a rigorous and punishing ICU fellowship to go into general pediatrics, and even with that change, my husband still threatened divorce and custody of our newborn. Even as I started looking for a less demanding job, he then decided to leave us anyways, which was his totally unhealthy and unsupportive response to major life changes he wasn't prepared for. In the end, I mourned both the loss of my marriage and my career as I once wanted it to be. I still have occasional pangs of regret. But in some ways, switching over to a different kind of medicine has been a blessing in disguise, as the hours make it more reasonable for me to be a single parent (I get no child support, financial or time-wise from him, as he moved across the country). It took a long time to adjust to the pace, the style, and the practice of outpatient pediatrics. And as you grow and develop in your new career trajectory, try to seek out the components of it that make it rewarding. Also...there are some people who after what would seem like a lifetime in one type of medicine, will end up doing a second residency to do another type of medicine (i.e. my family medicine uncle who at age 40 and with 3 kids started an orthopedics residency).

    Best of luck!

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  5. This letter made me feel really sad. I feel for you. One never expects this kind of thing to happen when we marry the man we love, but then obviously it does sometimes.

    I agree with the above posters. If you find you like Psychiatry, that's great! It will allow you to have more of a life outside of work. But I guess, what if he is still unhappy two years down the line, and you've pursued something that you're not passionate about? I don't know. I wish he hadn't twisted your arm so hard. That just sounds... bad to me.

    I'm thinking that he wasn't emotionally able to cope with the temporary craziness of residency, and that he blames you for his unhappiness. Having a child is stressful to a marriage. Being a resident is also. My husband and I DEFINITELY went through some tough times after our daughter was born, so I can relate to that pretty strongly. All that said, your husband needs to find a way to make HIMSELF happy.

    My husband and I were having a conversation last week about how trapped he felt at his job since I don't make much money yet. I pointed out to him that we weren't actually trapped. That he could look for a new job and even take it if he wanted, even in another part of the country, since I am in my final year and we could move anywhere. Just knowing he had the choice seemed to make him feel better.

    I don't know, maybe if the two of you could gain some insight into what else is contributing to his unhappiness, you could work together towards a solution.

    I hope things work out with you and your career choice, and I hope your marriage improves. I am so sorry this happened to you. Know that you're not the only couple who goes through rough patches. I hope this helps. Good luck.

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  6. I am also so sorry that this all happened to you. In addition to the comments already, a few thoughts:
    -Do you have a therapist yourself? Sounds like an outside perspective would be valuable now and into the future.

    -You might want to practice a one-line response to the people you run into who ask what happened. Something like, "Sometimes you just figure out that you need a change, and while I'm still adjusting, I'm really enjoying the new opportunities in Psych." A stock response might make these interactions less upsetting and help break out of that downward spiral.

    -It may not be possible now, when you've just started the new residency, but is there a way you can remain connected to the parts of Ob/Gyn that were most meaningful to you? There are psychiatrists who specialize in psych during pregnancy, or women with chronic pelvic pain, or if you loved the more procedural and fast-paced parts of Ob, then perhaps you can do extra time on psych emergency or inpatient units? This could also give you an easy response to the questioners- "I figured out that I wanted to approach some of the same problems in Ob from a different perspective."

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  7. Oh wow, my heart really breaks for you. Its very hard to do this without 110% support of your spouse, and it didn't seem that your spouse was willing/able (and this is not a judgement against him...not everyone is cut out for everything) to be that at this time. You have gotten some great insight above, and I commend you for trying to see the positive in your new second-choice life. I can also imagine it must have been really hard for your husband to suddenly find himself an often-times single parent to a young child...maybe he did in fact agree to these life choices, but both residency and parenthood are on the list of things you really have no idea about until you're really thrust into it...so making informed choices is all but impossible.
    As for your career path, I agree with trying to find aspects of the job that most resemble your favorite parts of OB & if you can't find anything (because psych is probably the furthest removed I can imagine) consider alternative paths---a different non-OB residency, doing psych for a while with the plan to go back to OB in the future, etc... Its easy to think "if only"---"if only my husband could've handled it better" "if only we didn't decide to have a child now" "if only our parents lived in town"...but life doesn't always work out perfectly, no matter how well you plan, and sacrifices DO often have to be made for the sake of family.
    You & your husband definitely need counseling, if you're not already going. There has got to be a lot of resentment and hurt feelings that need to be worked through on both of your parts.

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  8. I have made tremendous sacrifices for my husband during our relationship, including where I went to residency, my field of specialty, and the job I ended up taking... all influenced primarily by his choices. Do I feel bitter? A tiny bit, but I would rather be happy at home than happy at work (and I'm not unhappy at work), so I try not to dwell on those feelings. It's nice if you can achieve maximal happiness at home and at work, but that's not always the case, especially when there are small kids involved. I often think to myself that if I am unhappy 10 years from now, when my kids are more independent, I could always go back and retrain, or at least do a fellowship. (I can't imagine a new residency in my 40s)

    What struck me is the fact that you went from OB/GYN to psych. Obviously, psych is a great choice for lifestyle, but it's so completely different than OB/GYN. It seems to me that doing family medicine would have been a better choice, or maybe something you could consider in the future. If you did FM, there are plenty of family-friendly residencies with very reasonable lifestyle, and you could specialize in women's health and get to do a lot of what you might have done as an OB/GYN but with a more reasonable lifestyle.

    I agree with the counseling recommendation too. Although when is there time for that, right?

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  9. Wow this letter really shook me, as I am a single mom - divorced from a doctor. We are good now, but back then . . .

    Tough decisions in a marriage are hard, but the most important thing is that you make them together. This was obviously a control move, and the fact that you weren't totally on board for it portends badly for your future. Unless you go to counseling; SO agree with above. I am the cliche for "couple that goes to marriage counseling too late." We worked hard for almost a year, and it made our divorce more civil and amicable, but I wish we had the retrospective insight to have started long before "the beginning of the end." If you don't do something, resentment will build, and you will be constantly looking for that last straw to bail out of your relationship. I've been there. It sucks. When is there time for that? Make time. It is the most important time and money you will ever spend, no matter what the outcome is.

    As bad as divorce is, and as much as I don't recommend it, sometimes it is a good thing. It was for me, my ex, and my kids. It took a while to get there, but here we are, happily plugging along. When you are in a rough situation, it is difficult to see yourself objectively, as others do. Personal and marriage counseling can help.

    Good luck to you, I hope whatever you decide in your career and personal life you are happy. Make it your own decision, for you and your family. We only live once. We've got to make the best of it. I may not be an advocate for divorce, but I am a big advocate for personal happiness. In my situation, that required divorce. My situation is personal and private and very different from many. But I'm here now to try to give you and others strength to work on your situation. It's easy to maintain status quo - go along with habits in your relationship. The superstar works. You are obviously - OB now psych - a freaking superstar. Go hop on your invisible jet (Wonder Woman ha ha) and improve your life and those around you - most importantly your husband and child. After you. You come first; if you don't, nothing will follow.



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  10. Good luck to you. I don't have the answers but I can say you're not alone. As a surgery resident who loves my job, I feel like I am in this situation every day. You marry the man you love. With his support and excitement you consciously decide to have a baby with the man you love and then parenthood just totally changes you, him and your marriage. Just months ago I was done, in between the rock and the hard place, we were both miserable and I was truly ready to walk away. I went to counseling (he refuses) and now were in a better spot but not out of the woods. Incidentally, I have read Gizabeth's post "Walking the Line" (http://www.mothersinmedicine.com/2010/12/walking-line.html) many times over the past two years.

    There was a resident who started with me who likely switched residencies due to a similar situation. She seems happy enough, she has mentioned that it is nice that the teachers at school actually know who she is now. But, she would have made an excellent surgeon. She was the top of our class of residents. Life is so tricky and about all these choices with no good answers and no real balance. I'm constantly just praying for the guidance to do what is best.

    I will say that I didn't think the bitterness between my husband and I was affecting my daughter, but once things got better, I realized that although she was already a very happy baby, she was capable of even greater happiness and joy. I read somewhere in my search for clarity - you first, husband second, child last. It was an article about how most mothers think this is a ludicrous idea and that their child is ALWAYS first, but that is unhealthy. Well, I've noticed that maybe this is true.

    Good luck to you. I hope you can find support and clarity.

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    1. Thanks for the plug, Cutter. You made me go back and re-read that - I had forgotten. I feel the same way today I felt back then, only better with more distance. Good luck to you and yours.

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  11. How mt heart goes out to you!

    It sounds like you made the choice to switch programs under significant duress. So, no matter how it turns out, the way the decision was made will make it hard for you to accept, because it didn't come from within YOU.

    I agree with many of the above, said another way: "If mama ain't happy, ain't nobody happy". Pick the path that you foresee bringing you the most current and long-term satisfaction in life. Pick it now, YOU pick it in your head, the truth that is already there, that you know, deep in your gut, the choice of work and home combo that will give you the most happiness. Pick it without wondering what your husband thinks. Go on. Have a look.

    Found it?

    That's what you need to do. It may take wicked amounts of courage, if you decide to change things up. It may be that you realize that you are happiest in the current situation. The most important thing is, it has to come from inside YOU.

    Quick story - when I had my first two children in quick succession in medical school, I spent many a night crying bitterly, resenting my career choice, feeling trapped into the career by the insane amount of debt I had, and the two babies I now had to provide for, as sole breadwinner in our family. It was rough. Then one night, I imagined if I won the lottery. Like, over a million dollars. I could pay of my debt and be a SAHM like I wanted! But wait a minute... no I wouldn't.... I would still finish medical school and practice medicine, even if I didn't "have" to, because I love it. Plain and simple. It became my choice. So even though not one thing changed around me, my outlook shifted. Not to say it's all been sunshine and rainbows, of course not, but I have owned that decision ever since.

    Now, go own yours. And good luck. We are here for you.

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  12. Couples counseling is a lot cheaper than divorce.

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    1. Ha ha I'll echo that from experience. Divorce is truly a racket. There are good lawyers out there, I'm not trying to knock them here, but a lot of them feed on drama and drag things out to make money. In retrospect, I would have gotten a mediator.

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  13. No advice here, but just wanted to offer some support coming from a very similar position. I too switched from OB/gyn into a specialty with better hours and the option of more flexibility down the road- IM. I too have felt that pang of sadness and even regret. I can relate to wondering if it was the right decision or not. My new specialty- Internal med- doesn't suit me as well, and residency is still a grind. It is actually much harder for me because I am a "doer" and I really enjoyed surgeries and births. the patient population is harder bc I don't particularly enjoy abrasive male patients. I had all of the reasons for going into ob/gyn as everyone else who chooses the specialty. My PD was surprised I left it. It surprised me too, honestly.

    So, why did I do it? Well, I couldn't see myself keeping up with the grind forever. The pace was exhausting, especially when I had to come home late every night and then try to be 100% present with my son. I felt like my son was getting scraps, emotionally and physically from me. I didn't think I had the stamina to keep it up. I knew the sleep deprivation would wear me down over time. I knew that being an attending in ob/gyn is even MORE stressful than residency in many ways. I knew I couldn't do it and be the mother I wanted to be. I was a single mom at the time, so my partner's opinion wasn't even a factor. Now I am engaged to a wonderful man who I met in my OB internship and I am thankful that I made the switch for family reasons. I want more kids and I will be able to work part time if I please. I can have the energy and emotional reserves to be mommy first.

    I honestly don't knock your husband for voicing his concerns. Now, if you hold resentment GO TO COUNSELING because resentment will kill love faster than anything. I know that as a divorced woman myself. Don't let it build up. If you have forgiven him, and you feel good in your marriage and happy with your compromise, just go with it. Life isn't perfect. We hopefully make our choices in line with our priorities. If you husband and child is #1 and that means doing a job you enjoy but don't absolutely love, that is okay too.

    I think it is a common pitfall of perfectionists to think a good life that is not perfect needs to be made perfect. Maybe it is okay if life is just "good" but not perfect. We are all perfectionists, all of the moms in medicine. It is easy pitfall to demand perfection at the expense of happiness. So what if OB was a better fit? Is going back to it going to give you the ENTIRE picture of the life you want?

    Hope this is at least a little help to you. Best of luck and you are not alone =)

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  14. I think to make a clear decision you need to really search your heart about what being a mother/doctor means to you. I tend to be more pessimistic. two things that have moved me, I'll post the links below. Don't forget that Ob/gyn is a tough life. people can say "do what you love" all they want, but look at Dr Whoo's blog for a real perspective of what it looks like. If you truly are in love with it and want to go back, maybe that is your answer. But I sort of think you should really search your heart before making that decision. Your husband might have been the nudge, but switching out of a specialty usually takes some desire... anyway here's the links. moms will prob blast me for this...

    http://www.theatlantic.com/magazine/archive/2012/07/why-women-still-cant-have-it-all/309020/

    there's a freshmd post that really moved me, about balancing mothermood with being a mom... she works part-time and her blog has been a huge inspiration to me. it is great if you can comb through the posts



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  15. Life as an OB/GYN doesn't get significantly better after residency. It requires A LOT of late nights and long hours. If you can be remotely happy doing anything else then you should.

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