Friday, May 16, 2014

MiM Mail: Nontraditional student, school pressures, stalling

Hi MiM community,

I am a 31-year old medical student just finishing my first year (M1). I'll be 32 this fall. I got married last summer before starting school, and while my husband and I considered having a baby during the pre-clinical years, we didn't want to try until we had gotten used to our new married life and were sure we had gotten into the swing of school. Earlier this year I thought that maybe 2nd year would be a good time to have a baby because although my school has an attendance policy, it would be easy enough to stream. But then I started to stress out about Step 1 and wasn't sure how a new baby would enable me to put in 12-14 hour studying days and so I have been stalling. At this point, timing seems pretty bad.

I met with someone at school about best times and what I should know for planning, and they of course told me to do whatever I wanted, but that it was easier to take blocks of time off in 3rd and 4th year. So, right now we are thinking about trying starting later this year and having a baby sometime in 3rd year ideally, or 4th if it takes longer. We would like to have two, and I'm hoping that maybe we could have a second after intern year of residency (when I'd be 36 or 37). If it didn't happen, hopefully we'd at least have one, but I know we would both be a little disappointed.

I feel like I'm running out of time and I don't know how to handle it. I know everyone says there is never a good time, but it seems like all the times are downright bad and every time an opportunity comes up I get cold feet. I've been honoring most of my classes and would like to at least leave the door open for matching in fourth year and hopefully eventually a career in academic medicine (probably not in a hugely competitive specialty - right now considering EM, neurology, family med or internal med). I am nervous that I won't be able to keep it all up with a baby, or that the feelings of guilt I already have towards my husband and dog will only get bigger as our family expands. I already hardly see my family or friends and spend most of my time at home holed up studying.

What I'm hoping for advice on is:

1) Anyone have experience with a first pregnancy/new baby in M3 year? Any advice on how to plan for it or handle it well? Pitfalls to avoid?

2) In my situation, is it better to just try and wait until M4 and then PGY2? My fear is that since pregnancy is unpredictable, I'd rather start early.

3) Does anyone have advice on managing competition in class? I feel like I am putting a lot of pressure on myself to succeed to the point where I actually make myself unhappy and burned out and I'm not even sure how much it matters much in the long run.

Thanks for all you do. This is a great community and I am really glad to see the support.

11 comments:

  1. Where I went to med school was rougher on the M3s than the medical school associated with where I am now a fellow, but generally, M3 is a hard year -- we took 30 hour calls (man, I feel old) and worked 100+ hours a week. The students where I'm a fellow have it "easy" - working about 70 hours a week with two evenings until 10pm-ish a week. I can't imagine going through M3 pregnant or with a baby (it was the hardest year of my career -- MUCH harder and more time-consuming than being an intern.) I didn't have my daughter until PGY3, so I can't speak from experience, and certainly things are easier now than they were 5 years ago, but I wouldn't recommend it.

    I would strongly recommend taking a year to do research or grad classes or...not medicine between M3 and M4 (or between M2 and M3 if they'll let you) and having the baby then.

    In contrast to what I said about M3, I know a bunch of people who had a baby between M4 and intern year, or during intern year, or were pregnant for intern year and had the baby at the beginning of PGY2 and that's easier than M3 (at least in peds). Remember, As a resident, you're an employee -- you have maternity leave policies, you get paid money, you have protection if the residency program tries to discriminate against you.

    Med school is hard -- it's like a pressure cooker, because you spend so much time there. Looking back, I wish I had studied less, because no one cares what grades you got in med school or really even how you did on your steps, but it's hard to escape those feelings. I feel like I had so much more free time in residency and fellowship, because I had left that pressure cooker environment and I felt like I didn't have to "study" or being doing "research" in my free time. So, not helpful but it gets better!

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  2. Pregnant M1 here, due this summer- just do it if you want to have a child.

    Stop comparing yourself to your peers if you choose to have a baby in school, because they will seem worlds away, and it's a useless waste of energy.

    I was honoring in my classes before I got pregnant this year (with a toddler at home), and am passing now. I expect to be earning honors again when I am no longer pregnant/nursing, because building a human takes energy, and as a student it takes energy away from studying. There were physical limits this pregnancy handed me, and I made the obvious choice to favor my health and well being over points on tests this year. Pregnancy is ground zero for your child's whole life, and starting out in an ocean of cortisol is less than ideal. I'm doing what I can, and trying not to beat myself up about slips (caring too much about school, letting an upcoming final stress me out, falling asleep on my notes again - it hasn't been an easy pregnancy).

    I'm taking a year of leave after delivery, because our M2 curriculum isn't flexible, but it makes sense for me to come back and start with a new class once my 1 year old is sleeping through the night.

    Our M3 year is really tough, and we don't really have official safety measures in place to help you avoid situations in which you feel vulnerable as a gravid woman. I didn't want to be pregnant in M3 for this reason.

    I've gotten a lot of advice from professors, physicians who have kids, and there is no consensus for how to do this. Only, if you want to, you can make it work. You will need support from your family and your spouse. You will need to decide what your priorities are and stick with them.

    Lastly, you can't guarantee that you will get pregnant the very cycle you wanted, nor that you will stay pregnant once you do(1/5 pregnancies ends in miscarriage, etc). Give yourself some buffer time in your fertility window.

    If you can, get/be pregnant M2 year, schedule your boards during your second trimester once morning sickness has gone away and before you get too uncomfortable with a huge bump, and take a year between M2 and 3. That way you break up your time like the MD/PhD students, and can bond with the ones incoming to your new class if you need to.

    There are protections for pregnant/breastfeeding students under title IX, basically if your doctor says you need time or to postpone something due to pregnancy complications or recovery from childbirth, your school can't discriminate against you.

    Good luck!

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  3. I was pregnant M2 year and decided to delay the start of my M3 year by 6 months. Yes, this means I graduated late and started internship a year behind my classmates, but I didn't care. Taking that extra time off to just be a mom was wonderful.

    That being said, starting M3 year with a six month old child and taking q4 call and working 100 hour weeks (my med school was brutal), completely emotionally drained me.

    There are pros and cons for every situation you can think of. You will always have that next big exam to study for. There will always be demanding schedules. Just do what works best for your family. There is no perfect time to have a baby.

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  4. I had my first 10 weeks pre M1. M1 was really hard, but luckily, I go to a Pass/Fail school so the pressure wasn't there. Looking back, I honestly don't know how I did it. I was so freaking tired.

    I'm now a rising M3- but, 7 months pregnant and taking Step 1 in 1 month (ah!), I decided to take a research year instead of starting rotations. My school really didn't encourage taking only a half year off (like Katherine, above), so I am taking a year of personal leave starting after the Step. I plan on just enjoying being a mom for one semester, something that has been a bit crazy the past 2 years of school, enjoying my daughter and soon-to-be new one. The second half of the year I will be doing research, hopefully publishing some research from last summer, and boosting my resume with volunteering, etc.... I'm excited.

    As was mentioned, most people can't really plan their pregnancy to a T. My first pregnancy happened much quicker than my second- you really never know.

    There is no perfect time- but I would suggest planning school around life (baby, family) than the other way around. Some things are just not worth waiting for, and possibly missing out on. A career/school/rotations can wait. It'll work out.

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  5. Regarding the competitiveness/comparison, ever heard P=MD? Embrace it! You don't need to honor every class; you will get your MD even if you just Pass. Clinical feedback during 3rd and 4th years will go further than the number of Honors you get, and perfectionism is a sure fast lane to burnout. Being a nontraditional student, you bring something to the medical team that others won't - maturity, certain work/life experiences, etc. Learn how to not concern yourself with what the other students are doing. I was also a nontraditional student (matriculated med school at 28), and I had to learn how to let go of that ego-driven competitiveness. If you work on this early, you will save yourself a lot of heartache later!

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  7. 1. You are 31. Time is not "slipping away." It is not too late to have 4-5 children if that is what you want. But you don't! You still have plenty of time.

    2. I guess this all depends on your aspirations, but I am going to go out on a limb and say that it does actually matter how you do in med school and on your boards. No, you don't have to get swept up in the crazy competitiveness and make yourself sick over it, but getting as good grades and board scores as you can will give you more options when you apply to residency. It will increase your chances of matching at your first choice, and will give you more leeway in picking what specialty you want to do in a part of the country that works for everyone in your family.

    I may be biased (I had my baby during the dissertation phase of my PhD when I was 34), but as others have suggested, I love the idea of taking an extra year or two for research, and planning to try to have the baby then. It is much more chill, and it would give you the time to excel at med school AND put some extra stuff on your CV.

    All this said, if you want a baby right now, it can be done. 3rd year would be hard as hell though. No way I'd even want to be pregnant then. But that's just me.

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  8. Great post and great questions. I was pregnant during my MS3 year with an infant at home. Far from ideal. I also worked 30 hour calls with no sleep and did not even sleep post call, in order to spend time with my baby at home. I remember crying at some tough points during the pregnancy and wondering why I would have another baby when I couldn't even spend as much time as I wanted with the baby I had. Those were very hard moments. I also worried that my fatigue and stress would "hurt" the baby. However, she was born halfway through MS3 and I took a full year off (it is much easier to jump in and out of those clinical years) before resuming school. My daughter was perfectly healthy and has a bright and cheerful personality, in contrast to my "stressed out" pregnancy. I have another child who is high intensity despite what I thought was a calm pregnancy. They are all different and while your stress during pregnancy may be detrimental to you (as it was to me!!), I am not aware of any evidence that maternal stress in pregnancy is associated w irritable or otherwise unwell infants.
    I will be honest with you. It was and is hard. However, combining medicine and motherhood will always be a challenge. I hear your point that every time seems "bad", but I will offer the perspective that, no matter when it happens for you, you CAN do it. It will not be easy but it will be rewarding beyond all measure. I offer you this perspective with those two babies now 6 and 7, and a 3 year old, too. I previously wrote on this blog about the challenges of having babies during training. But now that I am through the other side, with no more cribs and diapers at home, I can tell you I think it is 100% worth it. I am trying to be your cheerleader a bit because I think you are afraid and I hope that you know that it is entirely possible.
    On the recommendation of several writers and commenters on this blog, I read the book Lean In. I high recommend it. It discusses many of the issues you have raised, including feeling "mother guilt" before you are even a mother!
    I hope this ramble is somewhat helpful. Bottom line - kids are amazing and so are you. It is challenging but infinitely rewarding. And you can do it. I wish you all the best.

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  9. Hi I am wrapping up MS3 year here with a 4 year old and a 9 month old. It wasn't ideal by any means, but we made it work. I was in my third trimester when I took Step 1. I was in an accident a few weeks before which threw everything off, I was in crutches and in bed but I just ended up taking it as scheduled. I probably didn't do quite as well as I could have, but I did just fine. I did my psych rotation, then had my c section. I took family medicine off and moved it to the start of my fourth year, coming up now. My school let me take a few independent study credits during my time off. I took 8 weeks off and went back to pediatrics. I won't lie, it was really hard. But, I also made it through with high pass grades. I didn't do as well on the shelf exams in my first two rotations back. When I got home I just needed to sleep or snuggle/feed my babies. It can be done though despite terrible timing :) and it all worked out. I also feel like I can do anything! All my attendings were really supportive too. My school worked with me. Taking a year between MS2 and MS3 or MS4 would be lovely though. I know several people that went that route and it was perfect. I just didn't really have the option with our family situation. On the other side of it though, I am happy it worked out. Honestly, many of my peers complain more about 30 hour calls... We moms are trained for it!

    Best wishes for whatever you decide and let me know if you have more questions.

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  10. I was pregnant at the end of M3(age 30) and ended up taking an extra year. This is very common at my medical school though and I was likely going to do it anyway as my husband took an extra year between 2nd and 3rd year to do a research year and we wanted to couples match. I highly recommend taking extra time if you can. I got to take 5 months off with my son after he was born and I don't know when else life could be so flexible for me to do that. Also, my fourth year schedule was very light after my applications were in, so I feel like I've gotten to spend a lot of time with him before I start residency.

    Another factor, which I hope doesn't apply to you is that you never know what will happen with pregnancy. You could have hyperemesis gravidarum and not be able to go to work. I ended up going into labor early and my son was in the NICU after he was born and if you're due to go back to school after a short maternity leave, that can make things complicated. As I said, these hopefully won't apply to you, but it's something to keep in the back of your mind.

    As far as boards/med school grades, it definitely helps, though I did not that great and was able to interview pretty well for Pediatrics (not a competitive specialty by any means). Things were complicated by the fact that I couples matched, but I'm happy with where I matched. I do agree that if you want more options though, doing well will help. So will your third year grades and if you have a newborn at home during that M3, that is not ideal. Just things to consider. Good luck!

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  11. I had my first baby right at the end of third year. I did a subI then switched to my MPH which was very chill. It was absolutely perfect. Medical school is a fabulous time to have a baby, but I would recommend M1 or M2 over M3 year. M3 year is really hard and I can't imagine having had a newborn then. My friend did though and took 6 months off. Bottom line: med school is a fabulous time to have a baby so get to it!

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