Showing posts with label MiM mailbag. Show all posts
Showing posts with label MiM mailbag. Show all posts

Monday, August 24, 2015

MiM Mail: Paediatrics training vs. family medicine

To the mothers in medicine team!

I'm a doctor working as a second year paediatrics registrar with a new baby and was hoping you might be able to give me some advice- I have struggled with choosing a career path for the last six years since I graduated from medical school- I generally don't like very stressful jobs but on the other hand, have always really enjoyed complex, interesting patients I've seen whilst working in hospitals.

At the moment, I'm a second year paediatrics trainee (and have yet to sit the exams for the college of physicians). I have a twelve week old baby and am contemplating going back to work where I will need to do three more years of training after my exams, of largely shift work (nights, evenings, weekends). If I do the training part-time, I would need to spend six years (and thats without having more children, which my husband and I would both like).

For these reasons, I'm considering changing careers to general practice (family medicine where I will be able to finish training in 18 months (or 3 years part-time and can say goodbye to shift work forever!). I think I will miss hospital-based medicine (and just getting to see children) but I think it might be more family friendly? Any advice from people with similiar dilemmas in the past, and how they decided what was best, would be really appreciated!

MPAS

Thursday, August 20, 2015

MiM Mail: Why the disparity in advice to prospective doctors?

Dear Mothers in Medicine,

There seems to be a disparity in the advice given to prospective doctors. Sometimes the tone is tense, heavy, and almost bitter. Warning people of the commitment, the intensity, the sacrifice of medical school and residency. And other times the thread takes a completely different tone and instead offers encouragement and suggestions for making it work, and the reassurance that more and more people are finding ways to get through those grueling years with a family.

As I try to work out the cost benefit analysis for myself, I'm curious how much of these perceived sacrifices and other costs are specialty based or otherwise dependent on the choices of the student. For example, yes, the financial cost of medical school is significant, but there are scholarships, there are repayment for service programs, and there are ways to mitigate the costs. What impact does the choice of specialty have on the stressors of residency?

How often are medical students able to get a residency near their medical school so they do not have to move their family?

Currently, my kids are 1, 4, and 5. To put the next 10 years into medical school means my kids may pay a steep cost during their childhood, and I'm not sure how much benefit they will receive. From their standpoint, I'm concerned this next step for me could be particularly hurtful. But I want to focus on primary care, which I suspect could be a milder journey, and therefore ask less of my family.

My husband is 100% on board. Wholly and completely. His work allows significant flexibility but insignificant pay. So he's happy to move with me and make this work. I just need to figure out what we'll be asking of the kids before we move forward.

Any insight for me?
Thanks.

Monday, August 17, 2015

MiM Mail: PCP to PM&R?

I am an older mom to a one and only, fabulous, wonderful little boy. I had a career in human services before medical school. I completed my internal med residency. I have worked as a PCP for about a year and, frankly, it's awful! I like my patients. I chose to work in an underserved area with a lot of folks who are newcomers to the United States and I really like this part of the work. I feel like all I do is tap on the computer instead of really dealing with the human being in the room with me.

I had never heard of PM&R in med school. The more I hear about it and read about it, the more I feel like it might be a good match for someone like me. (You know, someone who likes to talk to patients, take a history, do an actual physical exam, maybe have time to do a procedure....)

Does anyone have any suggestions about residency training? It doesn't sound like the PM+R residency would be that much worse than the schedule of an attending PCP. I am able to sacrifice salary due to a very type A doctor dad in the picture. (In that way, I am very, very lucky.)

Thanks!

Thursday, August 13, 2015

MiM Mail: Not excited by the OR anymore

Hello all,

I was a huge fan of this forum as a woman in medicine, and now I am a brand new mother to a sweet 1 month old baby girl.

I have completed the 4th year of a plastic surgery residency at a competitive and busy program, and am currently taking a research year to have more time with my daughter. My husband is in medicine as well.

I am writing because when I decided to go into surgery (albeit plastics, which is a little bit less demanding), I had not even met my husband and did not think I wanted kids. Obviously my priorities have changed.

Since becoming pregnant, I have been strongly considering a change in specialties or leaving medicine altogether. My new priority is being a mom, being present, and being focused on my daughter's upbringing. Plastic surgery demands long hours to build a practice, rigorous call, and exhausting surgeries that take a lot out of me by the end of the day.

I know switching would mean lengthening my training at this point since I only have 2 clinical years (and probably fellowship) after this research year. But I can't help but think this will be so much better for us in the long run. It makes me a little sad since I have invested so much in my surgical training already, but I don't know if I would be happy continuing on this track. I am not looking for an "easy specialty" since there is no such thing, just one that better fits my priorities. Otherwise, what other options are there outside of medicine?

I liked PM&R when I was a medical student and found it uplifting since you got to see patients' long term progress. I also liked emergency medicine for the immediate feedback and fast pace (the same thing that drew me to surgery initially). I think I need to bite the bullet and find something with more of a fixed schedule that allows me to focus on my family when I am at home, rather than being a slave to my pager. I am just not excited about the operating room anymore, especially given all of my life changes. I have never loved surgery the way some of my colleagues do, and this confirms it.

Any thoughts or advice would be so helpful.

Thank you!

Monday, August 10, 2015

MiM Mail: Lost

Hi, I just started a 3 year residency program, and I'm feeling desperately close to quitting. In fact, if it weren't for the huge financial investment I've made up to this point, I almost certainly would have quit before I even got to this point.

I have a daughter who was born at the beginning of 4th year, and I think 4th year was probably the best year of my life. I loved spending time with her at home (despite being bored and lonely for parts of it). Now that she's older, she's even more wonderful and funny and fascinating, which I didn't think was possible. I dreaded the start of residency, which was, unfortunately, a black cloud over that otherwise wonderful year.

Now that it's here, I don't know whether it's worth it to continue. I don't find the work difficult or all that unenjoyable; I kind of like it and I definitely like the idea of contributing to our family financially. I feel like I could surely handle it all if I didn't have a child. I grieve every single day the lost time with her and the opportunity to watch her grow and be there for her babyhood, which is so fleeting and the part of my own life I want to experience more than anything. Add to this some chronic health problems that I am dealing with, and I feel so depressed. And of course there's no time to seek out treatment or professional help. I really have nobody to talk to about it. I feel like I'm drowning.

I have a supportive non-medical spouse who has a good job, though it would still be a blow of course to give up a future physician income. And I do have some loans, though well below the national average. So...I guess I'm looking for advice. Do I stay or do I go? Or should I approach my PD about some sort of part-time compromise (guessing that's a huge long shot). If I somehow make it though, and don't destroy all relationships in the process, my husband and daughter would probably be better off long term. If I go, I can start to recuperate some sense of sanity and mental and physical health, and I think it's better for me personally. Maybe I could convince myself it's better for my daughter since she'll be in a less stressful environment. I feel lost. -J

Tuesday, August 4, 2015

MiM Mail: Taking the Plunge

Mothers In Medicine,

I am a married mother of 2 girls, 7 and 10. I work full time in the Information Technology, and am going back to school in the fall to complete my Medical pre-requisites.

I don’t remember not wanting to be a doctor – except maybe the phase where I was determined to be an astronaut. It wasn’t any one incident, or any driving force, just the knowledge that that was where I belonged.

Life has a funny way of getting in the way of plans. I struggled throughout my undergraduate degree with both depression and endometriosis, which meant I never managed to get the prerequisites under my belt. When I finally got those in control, life laughed again and I found myself a single mother to a beautiful girl. My program and parenting were not compatible, so I transferred out – determined to provide a stable life for my daughter. I met my husband, had another baby and went to work in a non healthcare field. It was fine. It put food on the table, clothes on my kids’ backs and a roof over our heads. We were able to take a yearly holiday, put money away for retirement and have the kids in competitive sports. I still thought about medicine, but it was what I considered to be a missed dream.

I made the mistake of taking a temp job in the healthcare field – just for a week to help out a friend. I was invited to come observe a surgery, and all of those feelings came rushing back. The closest I can describe it is the feeling I had when my children were first placed in my arms – I belonged there. Suddenly, I knew I had to go back to school and complete my missed dream.

For years I struggled trying to figure out how to get back into school. My husband and I couldn’t afford for me to quit work with two young children, and his support was limited. No one, not even him, understood why I would risk giving up a lucrative job in a stable industry, a good retirement plan, and a path up the corporate ladder. Eventually, this (among other issues) wore on both of us and we ended up separating.

Finally the stars have aligned. 10 years since I left the medical school path, 10 years since my first daughter was born and I am registered in fall classes. My husband and I have since reconciled, and he is now on board. The others in my life still don’t understand but are aware of the changes I am making. But I am terrified of the change. What if? What if I leave my career and don’t get into Medicine? What if I sacrifice my family in the process? What if we can’t afford it and I have to leave? What if I take this gamble and lose?

I imagine it as jumping into a lake. I’ve done my research, I know what the outcomes may be; now I just have to hold my nose, close my eyes and jump in. It’s terrifying and exciting all at the same time. For those of you who started medicine late, or after children - how do you take the risk?

Thank you, S

Thursday, July 30, 2015

MiM Mail: Studying in residency

I'm a 4th year medical student with young kids wondering how others carve out time to study in residency? Of course I'm sure I'll be learning quite a bit "on the job," but I'm certain I'll still need to be learning and studying more outside the hospital as well.

I recently finished my MS3 year and was able to have a strong performance on the wards and shelf exams this year because my husband was a rock star; there were so many times that I stayed at the hospital after a 12 hr day studying and he put the kiddos to bed on his own. I also got babysitters on the weekends before exams so he wasn't doing everything on his own. And of course I carried around study materials and studied whenever I could like when I was waiting to pick up my kids from activities. I'm just curious what other solutions people have come up with. I don't want my husband to feel like a single dad forever; needless to say 3rd year was tough for him because he also works full-time. My youngest (and last!) will be 2.5 years old when I start residency and my older children will be in elementary school. I'm going into anesthesiology.

Thanks so much!

Monday, July 27, 2015

MiM Mail: Spacing of siblings

I am a third year medical student interested in pediatrics and my husband is a 4th year medical student applying to EM. We have always wanted a large family and lately our (almost) three year old son has started asking incessantly for a baby as well. (When I asked him what he wanted for his birthday this year, his response was "a brother and sister.")

Our original plan was to have our second child during my relatively less busy 4th year, but now that I've started 3rd year rotations, I'm starting to wonder if it is a good idea or not. Balancing motherhood with being a student for the first two years was one thing, but these last few weeks have been an entirely new level of chaotic and stressful! Is it really realistic to add another baby to the mix right now?

On the other hand, having a newborn in residency seems like it would be just as daunting, and waiting until afterwards would mean that my son would be almost 10 before he has his first sibling and I would not have enough reproductive years left to have the big family we envisioned.

I know that there never is a "good" time to have a baby, but in your experiences - what has been the better timeline?

Thank you all so much! You have no idea how much this blog has helped me survive these last couple of years!

-K

Thursday, July 23, 2015

MiM Mail: What happens to friends and family?

Mothers in Medicine,

I'm a pre-medical undergraduate from Boston, entering my junior year. I aspire to be an Emergency Medicine physician. I'm finished with my pre-medical coursework, and the next step is taking the MCAT this Spring.

For the last two years, I pushed through my studies, blissfully ignorant to how my future career path may be incongruent with my deepest desire in life: to have children. So I'm writing to you because I aspire to practice medicine, but I'm held back by the concern that the doctor-mom work-life balance may not be right for me. I close my eyes and picture my future: My time is divided between my family and my career. I'm laden with guilt for missing pieces on either end. I'm in a perpetual state of "rushed."

I've been hunting through the Internet, and it seems as though some women in medicine feel this way. I'm attempting to be a nonpartisan hunter, because in the past my confirmation bias has prevented me from considering all of the information important for my decision.

I recently came across this website, which lists the 10 things you need to give up when you become a doctor. To be honest, I was disturbed by number six:

6. Your desire to always put friends and family first
As a doctor your job usually takes priority and you simply cannot shirk your responsibilities simply because you have prior engagements of a personal nature. Over the years I’ve known many difficult situations including a colleague who had to turn down a role as best man for a close friend because nobody could swop his on-call weekend with him and the hospital refused to organise a locum to cover him. Apart from sickness or bereavement, your first priority will be to your profession. Your friends and family may find that difficult to understand at first. They’ll come round to it with time, especially once they delete your number.

OK, so the author is a bit brute with the final comment, but as a general idea, it's that on the priority list, your career in medicine trumps the important relationships in your life.

After reading this, I thought to myself, "Well, shoot." This makes me squirm. I know in my heart that I would never be able to put my career over my family, in a general sense in life. But then I think, if any career were to necessitate this, it's medicine. It should be number one because it can be life or death; it's a privilege and a commitment.

I bet when number six plays out in reality, the choice between them is theoretical and it's all about balance. But the author does provide a concrete example of choosing between the two (with wedding example, above), and in that case, would I be able to choose my job? So... number six moves me to deeply consider my career options.

I 'd like to ask you guys how you feel about number 6. Are you saying, "Yes, medicine requires a commitment that may harm relationships, more so than other careers" or "No, you don't have to choose being a doctor over being a mom, no more than you would with any other demanding career," or "I never feel as though one is of more importance to me than the other" or whatever it is - I'd love to hear it.

Thank you so much for your time, I'm so happy to have stumbled upon your website. You are all inspiring. Wishing you the best in your dual careers.

Love and blessings. J

Tuesday, July 14, 2015

MiM Mail: Advice on starting med school with a long-distance relationship

Hi there future colleagues!

I am a long time reader of this blog, though so far I can't call exactly myself a Mother in Medicine - I am a 28 year old nontraditional student who is just about to start medical school one state away, with no kids. I have a wonderful, extremely supportive live-in boyfriend of 5 years who has been on this fun (-ish) journey to get into medical school every step of the way, though he will be starting business school this fall 8 hours away from me by car.

Our short- and medium- terms goal are to end up with summer internships in the same city next year and get engaged sometime after my second year/when he is done with business school. I will try my damndest to get some away rotations scheduled near him during my third and fourth year, and make every connection I can in my home state so we can ideally settle back here for residency, as most of his business opportunities are here (though really, who knows what will happen with the match). Eventually we would like kids.

As a type A, uber organized planner who is madly in love with this man, the uncertainty of a long distance relationship is quite scary. I am reaching out to this wonderful community to see if you all have any advice for me regarding 1) how I can set myself up for success in medical school to enjoy myself and eventually match well and 2) any tips for maintaining healthy long distance relationships.

Thank you in advance - I am honored and humbled to be entering into a profession with the inspiring women I see on this blog and I can't wait to hear your thoughts.

J

Monday, June 22, 2015

MiM Mail: Medical school timing

I have wanted to pursue medicine since first being exposed to it in nursing school. Throughout nursing school and my career as a nurse I have had a desire for the knowledge, skills, decision making and leadership that comes with being a physician.

I will be finishing my prerequisites in the fall and can take the MCAT in the spring with the potential of going to medical school in 2017 with an almost 3 year old and 16 month old. (I am currently 8 weeks pregnant!)

My question is, should I apply as soon as possible or should I spend a few years with my babies while they are still babies? Would it be easier to complete school if my wee ones are are at least potty trained?

A handful of physicians encourage me to do NP, CRNA or PA but I know I won't be satisfied as a mid level. On the other hand I'm not thrilled about all the time I'll be missing with my babies!

I'm 27 years old and my husband is very supportive. We could also get a nanny at any time if needed. Looking for some words of wisdom from those of you who have gone down this path! Thanks!

Wednesday, May 27, 2015

MiM Mail: Adoption advice

My husband and I just found out via my new, shiny, residency contract that my program (4-years long, medical (not surgical)) offers a significant perk of paying about $10k in adoption fees for employees and their families. We've always talked about becoming foster parents or adopting in residency or just after, but we never realized it might be to our advantage to consider doing it a bit sooner (maybe around PGY-3 or PGY-4?). I'd love some advice from anyone who's done either of these things.

Some background -- my husband is a superstar; he's in education and has been a teacher or school leader throughout our marriage, and found an awesome job in the city we're moving to. He's also planning on starting a doctoral program part-time online, to finish when I finish residency. We're open to staying for a chief year or moving for a fellowship, although I want to do primary care and so doubt I'd do that. Obviously, all of this stuff (my husband's schedule, his doctoral stuff, being a resident) is flying around in my head, and this decision is certainly not urgent, but we got excited at the idea that we could pursue something that's long been a dream of ours, and during residency training! Anyone have any advice for an ideal time to do something like this? Has anyone else ever done so! (Obviously, there is no "ideal" time, but some are better than others, and I figure 2-months into intern year isn't one of them!).

Thanks for the tips!

So thankful for this community.
- Future mom and east-coast resident, currently box-packer and barely-a-physician in the midwest

Wednesday, May 6, 2015

MiM Mail: Feeding a family

Another long day in the life of a resident, and I find myself at home wondering what to feed myself and my family for the next week. Hubs is willing to help, but lacks creative energy in the kitchen most days and doesn't like to spend much time prepping a meal. Munchkin is young enough to be happy with basic staples pulled out night after night, though she does express boredom at times and I prefer to introduce a variety of foods.

I found an app with associated website this weekend that will let me plan a menu with recipes and create a shopping list. I'm hoping with less call in the upcoming year that we will be able to eat more intentionally.

How do you keep your family fed? Do you plan ahead and shop for your weekly menu? How often do you sit down to a freshly cooked meal, and how do you get it done?

-One Hungry Mama, aka Ladybug

Wednesday, April 29, 2015

MiM Mail: Planning for baby #2

I'm a resident, wife, and mom to one, hoping to have one or two more children. My first was born during intern year, and we're planning for a second during residency. With my first, I ended up with multiple third trimester complications that eventually led to 2 weeks of bedrest and delivery a month early. I've been an avid follower of MiM since before my first pregnancy, and I'm hoping for advice and encouragement from some of you.

I'm in a field that requires a separate intern year and am now working with people unfamiliar with my first pregnancy. All they know is what I choose to tell them. I think my current PD knows I had complications, but not the specifics. Thanks in part to an amazingly supportive PD my intern year, I finished PGY1 and started PGY2 on time. From a residency timeline I'm right on track, and I have some sense of when the "best" times could be to have another baby during my program. We'd end up with about a 2.5 year spacing. Our preference would be somewhere closer to 2 years rather than 3.5+.

My spouse is great with baby #1, does a lot around the house, and picked up a ton of slack during my first pregnancy. It was hard, but we made it through, and my upcoming schedule will be easier than it was last time.

Medically, my odds for the healthiest possible second pregnancy considering my complications are higher if we choose not to wait until after residency. Besides, at that point I'll have written and oral boards and be trying to establish myself in a practice, so I'm not convinced it would be much easier.

In many ways, I feel like I'm between a rock and a hard place. When I think about attempting #2 during residency there's a part of me that wants to believe we'll make it through just fine, but the realistic side of me expects a great deal of physical, emotional, and mental strain. I wasn't deathly ill, but it wasn't fun, and both baby and I could have gotten very sick very fast. I expect to deal with some problems again, but hopefully not all, and hopefully not the one that led to bedrest. I'll be meeting soon with a new OB to talk through everything.

I don't want to sell myself short, and if I feel like having a second soon would risk compromising my training. On the flip side, ultimately we don't want to stop with one kid, and waiting would only compound my risks. Jumping to adoption is not the right answer for us.

Where we are now, we have a lot of support outside of residency. Even if we move after training, it makes sense to have another baby while we're here. I think there would be support from my program, but I don't think it could be as robust as it was with my first. My previous PD was amazing; few could measure up. My peers have verbalized a mutual intent to help cover for each other when circumstances arise including babies, but I haven't gone into details of my first with them and don't care to unless it becomes necessary. I don't see how they could understand what I was up against, or how it would help to talk about it right now. I sure hope I don't need weekly or twice weekly appointments until the last short stretch, but we might end up there again.

I guess I have an idea in my head that if I do decide to pursue a fellowship and don't finish residency on time, I can look for a job for a year, maybe a couple years, and then continue training. I may also be happy without a fellowship. I know people say it's hard to go back to a resident's salary (or worse) after being out for awhile, but we could knock out a lot of debt in a year or two and be in a better place for me to take a pay cut, even with 2 kids in daycare. I don't think the financial side would prevent fellowship down the road if I wanted it.

Anyone have advice for how, when, and what to communicate to my program and my co-residents if we do get pregnant again? Thoughts on trying during residency with high probability for some (manageable) complications vs waiting and dealing with recurrent and possibly worse complications? What else do we need to consider? Anyone else make it through a difficult pregnancy without feeling like you lost your competence as a physician?

Ladybug

Thursday, April 23, 2015

MiM Mail: Part-time residency?

Dear Colleagues and mothers,

I'm a final year IMG who, just like my husband, soon am about to apply for residency. The thing is that I am also a mother, and that's why I'm now writing here. I consider myself ambitious and strive to become a well-educated and good physician one day. However, my role as a mother is also of great importance to me and the responsibilities and duties I feel towards my daughter is something I cannot ignore. I strongly believe that I should not have to choose between career and family, which is why I wonder if anyone has any experience of so called "part-time" residency? Is it possible to get such an agreement anywhere? Where could I find more information about this? Also, would these requests lower my chance to match?

I'm interested in paediatrics, and with "part-time," I mean about 40-50 work hours per week instead of up to 80. Naturally I understand that such a "reduced schedule" also means a longer residency and lower salary, which I do not consider a problem.

I really appreciate all the help and information I could get!

H.P.

Thursday, April 16, 2015

MiM Mail: Having children with both parents in training

Hi Mothers in Medicine,

I am a longtime reader of the MIM blog, and really appreciate being able to read your stories. You are inspiring! I am writing to request advice, especially from those who had children during medical training with a medical spouse (or spouse with a very demanding career).

I am nearing the end of my 1st year of med school, and my husband is a resident in a surgical subspecialty, with 4 more years to go. We would love to have a large family (4-5 kids), and are a bit older than the average med student/resident so waiting to have kids until after training isn’t realistic. We are ready to start our family, but I am a little nervous about being the primary caregiver (with outside help) as a medical student. I know that my husband will make a wonderful father, but given his 80 hr weeks at the hospital he won’t be able to contribute as much time-wise. Having kids is super important to us, and some days I question whether medicine was the right choice for me, but I am doing well academically and I think I am on the right path.

Our tentative plan (acknowledging things don’t always go as planned!) is as follows, and I would love to hear your thoughts about pros/cons, other ideas and tips on how to make it work! We are considering aiming for baby #1 at the end of 3rd year. I would like to take a semester of maternity leave, then complete my year of elective rotations (daycare or a visiting Grandma for childcare), have baby #2 and take another semester off for maternity leave before starting residency. Has anyone tried to/ succeeding in taking 2 separate semesters off rather than a year at once for maternity leave? Is completing 80% of my clinical rotations while pregnant realistic? Any advice about the timing of clinical rotations? I hesitate to talk to my school’s administration, when did you approach them? Is starting residency with a 2 yr and 6 mo doable? Is it really possible to do a “part-time” residency? How difficult is it to take the full 12 wks of FMLA for maternity leave during residency? Am I crazy for thinking that this sounds like a reasonable plan? Have you been through something similar and barely survived, or were you able to thrive? Any advice would be greatly appreciated!

-K

Thursday, April 2, 2015

MiM Mail: How are your kids that grew up with a Mother in Medicine?

Hi MiM,

I am an M1 with a 7 month old baby. I was so excited to start but phew, it has kicked my butt. I have great childcare and a very supportive partner but I struggle with constantly feeling behind - behind on house work, on study, time with friends. And of course, my sweet daughter. I worry a lot - is she going to be ok? Will she still be strongly attached? Will I miss being home with her more when these "little years" have passed? I would love to hear your thoughts on these. Not so much "mom guilt" but for those whose children have grown up while they have had a career in medicine - how is your relationship with them ? How are they? Do you regret being gone? Any tips as to how to treasure the time you do have without being bogged down in the never-ending "to-do" list? I spend my days off with her trying to do laundry and purée baby food while longing to just play. Balance is hard and I'm feeling the tension.

A

Monday, March 30, 2015

MiM Mail: Pressing advice needed for an IMG

Hi MiM,

I need some advice.

I’m a 34yo IMG who graduated and returned back to the USA a few years ago, keeping busy with research and odd biomedical-related jobs, but I’d basically given up hope that residency (and medicine) was in my future years ago. During that post-graduate time I also met and married the love of my life. We’ve been trying to start a family for the last couple of years, but were eventually diagnosed with unexplained infertility. It’s been incredibly frustrating – we’re both perfectly physically/genetically healthy and under 35, but what happens so naturally for others just wasn’t happening for us.

Over three months ago, in December, an opportunity fell in my lap to interview for a one-year preliminary position in Internal Medicine with a large community program that is currently not in the Match. The interview went well, I was immediately offered a position, and signed a letter of intent on the spot. During that time, knowing that we were not getting any younger and you just never know what the future holds, we decided to progress on to IVF. First attempt was a bust, and absolutely emotionally crushing for both of us. Then last month we transferred a couple of frozen embryos into me, and yesterday I got the results from my first beta-hCG blood test – big ol’ positive! In fact, it’s looking like it might well be twins (instant family!). I’m still being incredibly cautious about my optimism, but we’re both certainly happy at the news.

So now I’m left wondering how to handle this upcoming prelim position; they sent me my contract a couple of weeks ago, but I admit I’d been dragging my feet and sitting on it for a while, wondering how this whole IVF thing would play out and how I could/would juggle the two. In an ideal world, I could talk to my program director (who is incredibly nice, so far) about the possibility of starting this one-year gig next year (they’ll still need interns next year, right?). I know this is a job, not some schooling I can defer, but it seems, based on anecdotes here on MiM and elsewhere, that it’s a remote possibility. That being said, I know I’m incredibly replaceable, and I already got the sense that I was offered this position out of pity. My husband and family and friends say to sign the contract (otherwise I lose leverage) and then discuss the pregnancy with the PD and hope for the best. Meanwhile I’m worried that once I sign the contract, I enter into a binding agreement for the year, which makes it difficult to potentially postpone it until next year (if that’s an option). I wish I could discuss it with my PD, but I’m afraid of scaring him away to the point he’ll just decide I’m too much trouble and just walk away.

Maybe I’m just over-reacting, but I’m really not looking forward to the idea of basically spending the last two-thirds of my first pregnancy as an IM intern at a busy community hospital. I know from stories that internship and pregnancy by themselves can be physically and mentally difficult (and frankly, part of me fears them both), so to have to deal with them concurrently – especially as a ‘geriatric’ pregnancy, possibly with multiples – is just NOT something I’m looking forward to dealing with. It’s particularly worrying for me because I know this is an opportunity for me to shine and potentially continue on within the field of medicine, but I have the very real concern that I will simply not be at my best if I’m pregnant during internship and therefore not do my future any service.

I know I put myself in this position, but I'd welcome any advice!

Thanks,
DrDel

Monday, March 23, 2015

MiM Mail: Ever too late for medicine?

Hello, I am a 34 year old working mother of two young children (3.5 years old and 14 months). I have been working as a research scientist in the pharmaceutical industry for a number of years now. I have been thinking of becoming a doctor since 2005. I applied to one local university in 2012, received an interview but was put on the waiting list thereafter. My husband is very supportive of my decision to pursue medicine and I would like to reapply at some point in the future. There are a few things holding me back from applying any time soon though. We would like to try for a third baby before it becomes "too late" age-wise. Also, I'm realizing more and more that I like to be heavily involved in my children's lives. I enjoy the home-making side of my life very much and I find it difficult being apart from them for extensive periods of time (my current job is about 40 hours a week and I'm ok with that because I get to have dinner with the family, put kids to bed and have weekends with them). I very much want to pursue medicine but I'm so scared of losing the family side of my life and that I won't really be a part of my children's memories if I'm busy in medical school and then long hours in residency and as an attending. I have no problem studying (I love it!) and working hard, but I want to be there for my family. So my question is, would it be completely unreasonable to postpone medicine for a few years, maybe 5? 10? Or whatever it takes for me to feel that I have nurtured my children to the point where they are ok with me not being there often? (I have heard of women successfully entering medicine in their 40s and even 50s). I have no idea when I would feel "ready," and I know that age can be a factor when you want to pursue certain specialties, but I'm actually interested in family medicine with a focus on OB. I'm just having a hard time envisioning myself being both a good mummy and a good doctor at the same time. I feel like one area will suffer, and for me, my family is my top priority. I have several doctors in my extended family and have talked extensively with them but they are all males so I have not had much female perspective other than what I have been researching online and reading in books. I would really appreciate your feedback on my dilemma. Thank you so much for your time.

Monday, March 16, 2015

MiM Mail: (Un)happy match day - "It doesn't matter what YOU want"

As match approaches, it is with a heavy heart that I await the results.

This is a story which has been culminating over the years, and in fact, I have many unsent emails addressed to MiM which tell the tale. I am a 4th year medical student with two girls - a preschooler and a toddler. Both of these I gave birth to during medical school (I "took a year off" and did an MPH between 3rd and 4th year). I am married, and it is not a match made in heaven. Few relationships are perfect, but I feel like ours has some really deep underlying issues that perhaps make it stand out. We had a fun relationship in the beginning - but we got married more so because of an unplanned pregnancy. We were legally married in a courthouse. It was important to him to get married prior to the birth because he was already plotting his custody rights. I didn't tell my mother, who would have counselled me against it (and she would have been right), and none of my family or friends were in attendance. I worried about our significant age difference, but he promised me support, and we framed the relationship in that way - he has no competing career, which frees me up to pursue mine while having a secure family life. (Perhaps something like this.)

I wanted to send this story in because the title of the previous mailbag letter, "Whose dreams come first?" struck me. The reason that this resonated with me so much is that my husband told me when I was explaining my rank list, "It doesn't matter what you want."

Having children during medical school has been extremely draining, and now that I am plotting my career path, I wish I had more control over what I wanted to be and where I wanted to go. I am an excellent student and work extremely hard. Despite being a full time student, I have also taken extensive care of my children, especially as babies. I have "studied from home" while taking care of my children as infants for about 3/5 years of medical school/MPH (M1, M2, MPH) so that my husband would continue to have opportunities to work. Opportunities that I don't feel he ever took advantage of.

My husband and I have no family nearby and no family equivalents. As a result, all childcare responsibilities fall completely on us, unless we pay a babysitter. We did have a regular sitter 3 days a week for about one year, which I think was an overall great experience (with the exception that I felt from my perspective that we were hiring her so that my husband could work, with the implicit understanding that as a medical student I needed to work all the time, but from his perspective I was hiring her so that I could go to school while preserving his autonomy), but she went out of town and since the financial equation didn't add up (his overall work income = cost of sitter, and that includes time that I took care of the kids for him to work as well) by mutual agreement we didn't find someone to replace her.

There is not much of a culture of stay at home husbands of doctors. I have seen several blogs out there of the proud and self-sacrificing "doctor's wives" but nothing similar to that for the "doctor's husband." These blogs tell of the hard work of the male doctors, the pride of the doctor's wife in her husband's service to humanity, her story of self-sacrifice for her husbands career, helpful recipes, and parenting tips. My husband doesn't feel this way about my career at all. Perhaps it's because this culture doesn't exist for him. We are essentially at odds about my schedule, my need to study, the housework, the possibility of needing to move.

Because my husband decided on his own volition to be a stay at home dad, he now makes even more minimal income than before. He receives a $1000 annuity monthly from an accident.  I transfer money to him to pay the mortgage on his house/workshop and other bills. Most of it is money from my mother, and she is sending it via me to him with the understanding that he is supporting me in my career and taking care of her grandchildren. He says that he has "sacrificed" his work for my career, but in fact he adamantly did not want to get childcare and work. He has not given up financial security either - when we met, his bank account was completely overdrawn. He has recently characterized himself as been a "servant" of my "wealthy family." However, suggestions I have made that would make him more financially independent: renting his workshop space for income, getting a regular job, etc, have previously been shot down as inconceivable. We paid his leftover defaulted college loans - from almost 30 years ago! - with our tax return credits. I have also enabled him to pay off credit card debt. Meanwhile I feel like I have sacrificed much of the quality of my medical training for him, having lost out on the experience of a normal M1 and M2 year and career development opportunities along the way, but still taking on full expenses for the family either via loans or via my mother's contributions.

Rewind to the end of 3rd year: I am 9 months pregnant and concurrently preparing for the medicine clerkship exam,  starting MPH coursework, and studying for Step 2CK. I destroy the exams because I work hard. I am a machine! Woot! But things really go downhill over the next year. While in labor, I try to write a paper. It exemplifies my experience over the next year: working in pain. The intense emotional pain of trying to do well in school while your infant cries. I had done something similar in M1 year, but the memorization was much more tolerable than the reading and paper writing. And things are much more complicated now with two kids. My husband had encouraged me to do the MPH because of financial reasons - the fact that I will continue to have loans available and that my mom will continue to contribute to us if I am in school. After trying to write my paper between contractions, I give birth the following morning. It is a joyous day. Shortly after, I initiate total 24/7 care of our second child while taking 6 online courses, about 60 hours per week of work. His contribution is taking care of our oldest about 2/3 to 3/4 of the time, and taking her to school every morning. I work from 9pm-3am every night (the hours she most predictably sleeps) plus whatever else I can get my hands on. Even with this, he is pressuring me to do more school pickups for our oldest so that we are being "fair." In all this time, he theoretically could be working at least between 9am and 3pm M-F (and longer when I do pickups) but apparently does not since my mom is still paying the bills. I am feeling like sh*t, alone at home (online courses), taking care of baby, working, doing all laundry, washing diapers, most of the housework, plus the winter is complete hell and I can't even go outside for fresh air or a run because it is too cold for the baby. His first conclusion is that I am cheating on him with a classmate because I am withdrawn from him. !!!!?????! WTF ??????!!! I blow up. I tell him that I don't like him. That I could have done better. Someone younger, better looking, and more financially secure. Yes that is a very hurtful thing of me to say, which is why I guess I didn't say it until it really came to a head. And yes, I knew this about him going in, but I valued the support and partnership he promised more than any of those "shallow" things. I guess, when I felt the support slip away, I wished I had at least some of those shallow things left to hang onto.

He goes and talks to his friend who graduated from law school. Then he tells me that if I leave him, that he will keep the kids in the state. The other stuff he talked about "is between him and his lawyer."

I wish I had initiated something then (legal counsel?) but despite these misgivings, I had no plans to divorce him.  I felt like I had made the commitment, and I was going to do the best I could with it. Perhaps it was me (too picky? don't deserve better?), perhaps I would just never be satisfied with anyone, so I should try and make it work.  Living with him seemed and still seems like the only way I will ever see my children as a medical student or a resident, and they are young. They also love him and I don't want to take them away from him. I value what he provides for them as a father. So I kept it going. M4 starts and he now has finally taken over full childcare responsibilities.

He was not supportive during the application process and was more interested in my lack of sex drive than my career prospects. Then he blames me for not having worked hard enough to find a good program in our area and says I don't deserve "the best" that I should settle for "good enough." I feel like this is a recurring theme in a lot of his beliefs. He has a disdain for wealth. He calls me a "princess" for wanting to live in a nicer house and city. I am not a pro-wealth person and have a fairly nuanced view on the relationship between income and happiness, but he is full out against it, perhaps a defense mechanism for his personal lack of financial success or stability. I don't know if this attitude can be resolved. When I say that my career will bring the family financial stability, he says our kids can go to community college, take out loans, and that they would be happy living out of a van or homeless shelter. Maybe there is some element of truth to this. I think they will be happy anywhere they are with a loving family but I wonder if we can provide that.

I interviewed at 11 programs, 5 within our city and 6 around the country. In this process I have sought out advice from many people, only one of whom said I should make the "self-sacrificing" choice, most who said I should pursue my "dreams." Many have said that my husband can't keep the kids if I move out of state (they are wrong - our state favors keeping kids in the state and I confirmed this independently).

My mother called my husband and asked him if he will support me. He said he was not moving. Why? He was protecting himself from divorce because if he stays put, the state custody laws favor him, but if we move to another state and I divorce him there, then I would be more likely to maintain custody if he then moves out of state. I asked him whether in this scenario (refuse to move, keep the kids) he would continue to ask me to pay his bills? No, apparently he will get it together. Call me doubtful, but he could not pay his bills prior to having children. And wow, if he could actually work to pay the bills, then why wasn't he doing this all along? The wildly emotional thoughts running through my mind include:this man is going to take my kids from me AND live off my future income unless I do what he wants.

Long story short I submitted my rank list while sobbing. My top programs are somewhere in the middle of my list, probably never to be realized. I have given up on the possibility of living near my family - consisting of my mom and sister. In fact, I did not even rank my preferred specialty first given I was so disillusioned, and I really regret this as well. I often wish I had submitted the list I wanted and dealt with the fray rather than be here in this limbo, unable to change or withdraw my rank list. But it was my children that he threatened to keep from me. My children. It made me crazy. (He would say: no, he did not threaten that - all he said was that "I'll keep them in the state" - he is a stickler for legal language.) My mother withdrew her financial support of him and he is now calling her evil and manipulative. She will no longer help us buy a house that he would live in. Nor should she. He now says that since I'm not paying his bills that I need to share half the parenting, including school drop offs at 8:30am (long after I am supposed to have reported to the hospital), BUT that I should NOT quit medical school. I don't know if he actually expects me to do this, or if he is just holding it over my head that I CAN'T do it.

He is looking at my future resident's salary, most likely the local program I ranked first, and salivating with the income "boon" - not concerned about what it means to me. I have watched my fellow "MiM" classmates give up their dream residency for their husband's careers, and I felt bad for them. I feel less bad for those who make the practical decision because of close-by family who are supportive. Now I feel bad for myself. I do not want to pay this man's mortgage with my blood, sweat, and tears. But he has my kids, and I will not have the hours in the day to take care of them for a long, long time.

We are in counselling now and I feel worse and worse about him the more I think and talk about it. I don't think I can forgive him for the position he postured. As far as the possibility of divorce goes, I am sincerely worried that I would lose custody of my children because of my work hours. I could drop out of residency after my contractual period and then divorce him, at possible loss to my career. Then there is always the possibility of a match day miracle, whereby I get the program I actually wanted. I suppose if that happens, I will have to be nice to him if I have any hope of making the move with my family. Or, I will submit a waiver to my dream program. Or I will visit my kids on my day off. Or at this point, do I actually want that program anymore, given that I have already started to plot a career that would be better for a single mother or co-parenting situation?

I know I am not his ideal wife. I don't idolize him and will probably never be in love with him. But I have given him so much of my life. I am willing to work with him in a partnership and possibly even an affectionate relationship for mutual benefit. Perhaps I am willing to settle for "good enough" in this "romantic relationship" part of my life, but not at the expense of settling for "good enough" in the professional part of my life? He probably feels the same way. He is willing to settle for "good enough" in our relationship if we don't move and everything stays status quo, but requires my adoration to move. But I can't fake adoration. I alternate from feeling like maybe I am a "privileged princess" to think that I could actually rank the program I wanted first - big whoop, who cares, you're going to be a doctor no matter which program you go to - to feeling enraged that I worked so hard against so many odds and am placed in this situation where I have to settle.

Maybe the best solution would be to get divorced after Match but prior to graduation, drop out after the contractual 45 day period of residency or apply for a waiver, enjoy a year with my children in the interim while HE works, and apply in a more single-parent friendly specialty with the new understanding that I am restricted locally, and with a feasible plan to co-parent. Compromise like hell, but more on my terms and with more warning.

It took me some time to get oriented on my career path with some bumps along the way as a young adult. Now I feel like I am pining for my own lost potential of self-determination that I was finally on the brink of realizing. My sister recently married a nice young man she has been long distance dating for years, who will follow her unpredictable and highly specialized career anywhere, and is excited to do so, a comparison that is painfully made. I will never get to marry a nice young man who is willing to unconditionally support my career. I will never have the experience of my family celebrating my wedding day. I will never feel deeply head over heels in love with my husband. I will never have autonomy over my career. I have what I have. Such beautiful and wonderful children! So much! Everything!

But so hard.

Well, that is my long story. I don't know what kind of advice I am looking for. Past experiences? Commiseration? Strategy? A reality check?