Showing posts with label having kids during training. Show all posts
Showing posts with label having kids during training. Show all posts

Monday, May 25, 2015

The end?!?

This morning I walked into my final official overnight call shift of residency. It is surreal to think that just 3 years ago, I began residency. I had absolutely no idea what it took, but having been a pretty good medical student I thought, “I can do this!”

Premedical studies, medical school, marriage, motherhood, and now residency have taught me about my ability to persevere, to thrive, to love and be loved. More so than the extreme highs and lows that come with providing care for a broad range of children from the critically ill to the chronically affected, you realize it is the day-to-day provision of care that is the most long-lasting. What you do on the average day at work, if your colleagues feel supported or unsupported, if your work leaves patients feeling cared for, if you managed whatever major things they were seeing you for, that’s what matters the most.

I think at the end of my shift tomorrow I’ll do a little happy dance to mark the end of an era. I am a lover of daytime work, of seeing the sunshine in the morning, of being at home when my family wakes up. I gladly mark the end of leaving home in the dark and trying not to wake up our toddler as I hustle to find my shoes. I gladly mark the end of back-to-back consult calls from the Emergency Department or outside hospitals for admissions. I sadly mark the end of seeing my favorite overnight nurses and of running efficient rounds. I sadly mark the end of being the “Senior Resident on call” answering questions for outside providers.

The end of residency overnight inpatient call and the beginning of Attending at-home call. Sounds nice to me.

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 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

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?

Thursday, March 5, 2015

MiM Mail: Whose dreams come first?

My name is Jenny and I am 24. I am a single mother to a beautiful 6 year old and a handsome 5 year old. Their father is not really a part of the picture. I receive no financial support from him and he sees the kids once a week for about 8 hours.

I am a research assistant at an amazing lab and absolutely love research. I have planned on going back to grad school soon. The grad school where I'm located also has a med school and there is a MD/PhD Program. I have always dreamed of going to med school. It was my dream since I was 12. And even when I became a teen parent, I still knew I wanted to go to med school. But I never thought I'd had to go as a single parent, so I've gone a different path which has led me to research. As I start to prepare to apply my heart screams with such a passion that it becomes difficult for me to hold back the tears. Med school is where my dreams are. Research driven physician is where my heart is. It's what I've always wanted. But I'm a mother now and a single mother. The program is ideal because of the stipend. I cannot take 4 years off work to go to med school when I have children. But with a stipend I could get by. And I know I have to apply. Even if I don't get accepted, I have to apply. But if by some miracle I do get accepted would it be right for me to go? I have been in school for the majority of my children's lives. If I was to do the program, my kids would be adults when I finished. My daughter would be 19, my son going on 18. I would have spent my children's entire childhood in school. How is that fair to them? I would be so busy with school there would be no dating, no man to step up and be a step father. It would just be us with me always in school and studying. My kids will be adults. I'll be 37. And eventually that will happen anyways, but how much will we sacrifice if I kept going for my dreams? Isn't the mother supposed to put the child's dreams first? I don't know what to do. I feel either choice I make will break my heart. I would appreciate any feedback.

Thank you,
Jenny

Monday, January 12, 2015

MiM Mail: Starting medical school, need encouragement

Hi MiM,

In six weeks I am supposed to start my first year of medical school. It's been a long time coming. I trained as a nurse, worked as one for a while, and then decided to pursue medicine. I finished off the prerequisites I needed, applied and got in (to a medical school in New Zealand - where I am from originally). My husband and I had a surprise pregnancy right before I was supposed to start medical school so I deferred for a year. I now have a gorgeous six month old and have been enjoying working casually as a RN. However starting medical school beckons, and I find the idea now terrifying. The unknowns of how to manage it all with a baby. I have an extremely supportive husband but he is also studying a PhD so is busy. We have great childcare sorted - our baby will be at the university day care right around the corner from the medical school. I'm not really struggling with the idea of leaving my baby as I'm not the full time stay at home type, but I am afraid I will find school all consuming and miss out on her. Also from a financial perspective having us both studying sucks - my husband gets a small stipend we can survive off but it's hard when our friends are buying houses and taking dream vacations, and we can only afford meat once a week! I suppose I am using this post and community as I imagine many others do - to seek out encouragement and to hear stories from those who have gone on before. How did you do it with a baby? Any ideas on how to manage financially? Is it worth it in the end? Etc. Would love any encouragement, inspiration, advice you can spare.

Thanks so much,
A.

Friday, January 2, 2015

Princess Service

“Your Princess Service has arrived.” At the end of my holiday shift, those words uttered from the lips of my Dream Guy, were like music to my ears.

I just completed a 6 day holiday shift working what our residency program has deemed WARS (working at reduced staff). You work up to 6 shifts in a row and get either the week of Christmas or New Years off in addition to your 3 weeks of vacation. I gladly got one of my favorite inpatient services with the Division Chief that I most admire. However, after morning 3 of waking at 5am to arrive for sign out by 6am, I was tired, my feet hurt, and I was forgetting what sunlight felt like on my face.

Three years into residency, our family knows to plan for rough stints like this and to have extremely low expectations for how our house will look (though I am so ashamed about how cluttered our bedroom is and bemoan its state daily with apologies). My in laws came into town on day 1 and are staying for 4 days after.

My day of work ends with O calling and making some silly joke about my “Princess Service”. The staff members here call being picked up or dropped off from work “Princess Service” and O has added it to his lexicon. I don’t think he quite knows that it is one of the highlights of my day.

I have arrived home daily to Zo playing on the floor with his grandmother with blocks or making Playdoh cookies, a glass of wine waiting for me, and delicious vegetarian fare cooked by my in laws or my husband. By around 8pm I can be found in my pajamas nodding off on the couch while someone else does the dishes. I somehow make it through story time and have been in bed by 9:30 or so every night. O and I watch our new favorite on-line miniseries, this month it’s American Horror Story, and I pass out.

WARS has ended and I begin the next part of the end of this year, applying for my medical license in the 2 states that we would love to end up in, and preparing for my next interviews.

Here’s to all of the Princess-Mommy-Doctors out there. I hope during this holiday season you feel the joy I feel each time I hear “Your Princess Service has arrived.”

Wednesday, December 31, 2014

MiM Mail: Defer or start medical school with a newborn?

Hello MiM!

I am a mom of two kids - one in school, one starting next year - currently in university in and applying to medical schools in Canada. MiM has been an inspiration since I started working towards a career in medicine, and I am thankful for all the stories that have been shared here.

To get right to the heart of the matter, I am pregnant with our third child and due in late August. I'll likely be delivered 1-2weeks early due to my history, so by the start date of the med schools Kid 3 will only be a few weeks old.

Acceptances come out in the spring, and I need to decide (if I get in!) whether to defer for a year or whether to start med school with an infant just a few weeks old at home, which will also have meant a big move while 7-8 months pregnant. I would imagine, in the circumstances, I could likely get permission to do the first few weeks' work from home, something I have heard of med schools allowing before.

My husband will be taking eight months parental leave for Kid 3 in addition to any leave I take, so we won't have to deal with putting a tiny infant in daycare and I will have help at home during that transition time.

I am hoping to hear from MiMs who have experience with having babies during first year. I have a few months to mull over my options, and if I don't get any acceptances it won't be necessary to worry, but ultimately I would prefer not to take an entire year off from my education if I could be okay with just taking a few weeks at the start of the year.

Your input is much appreciated!

Thank you,
MiM in Canada

Tuesday, December 23, 2014

Guest post: Having Babies during Residency: A View from the Bridge

This post is in response to our MiM Mail: Residency limit for leave and having children posted in November.

The problem of maternity leave for residents goes well beyond the good will, or lack of it, of training directors and local programs. Different specialty boards establish minimum standards for residents to be board eligible, and these usually involve specified upper and lower limits of time spent in particular areas. Stipends come from multiple sources and are tied to the work that the resident does, which makes it difficult to set aside money from one year to pay for time doing make up work in another. When a resident goes on leave, other residents have to pick up her responsibilities, and they will not receive compensation for doing so. At the same time, they may not violate duty hour limits.

Program directors, of which I was once one, have to figure out how to create maternity policies that do not violate minimum requirements, do not unduly burden other residents in the program, do not violate other regulations and still acknowledge the legitimate needs of the resident who requests leave. When I became a program director, my youngest child was 4, and the issues of maternity leave were still very fresh in my mind. My first thought was to ask the department to hire a PA or master’s level nurse who could float to cover the clinical responsibilities of residents who took leave. That went nowhere, though I still think it would have been feasible and fair. I then tried to get the program directors organization to survey its membership to see what different programs were doing. The push back was immediate and negative. Programs with generous leave policies were reluctant to publish them, for fear that residents would select them to take advantage of them, multiplying the headaches of trying to make accommodations. Many programs had no policies at all.

I am sad to see that so little has changed in the last eighteen years—soon, my daughters will be the ones who have to deal with maternity leave. Change is unlikely unless more women become program directors and choose to work on modifying the policies of various specialty boards. The family practice board position (see MiM Nov 10, 2014) is one that others could adopt. It suggests that programs might create some creditable elective time that could be spent reading or doing some other scholarship from home. Women should be allowed/encouraged to schedule the more taxing rotations early in pregnancy (and I would suggest also front loading as much call as one can). It is still up to the program how much leave to allow and whether it will be paid or unpaid. The AAFP also leaves unanswered how to deal with what may be competing demands of the law in a particular state and the requirements of a specialty board.

In the end, women physicians cannot expect to be treated more fairly and generously than other women. Having a child during training will never be easy, but we should be mindful that we are generally privileged. We may have to delay some phase of education, or prolong it by working part time, or even chose a specialty or a position we would otherwise not have done, because of having a child. Compared to the pregnant UPS driver who gets fired, or the Walmart worker who has to stand on her feet all day, or the mother who can’t work at all because she can’t afford childcare, we are lucky indeed.

-juliaink

Monday, December 22, 2014

MiM Mail: Med school with young children

My name is Megan. I have 2 children. My son is 2 1/2 and my daughter is 7 weeks old. I am only 20 years old.

When I was younger my dream was to become a physician, specifically an OBGYN. When I had my son at the mere age of 17, I figured that dream was over. I decided to settle on nursing with the hopes of becoming an L&D nurse. I started going to school; while taking pre-requisites for the nursing program, became a CNA. I started working as a CNA at a hospital and had my daughter when I was 19. Having a second child while still being a teenager didn't stop me from going to school. However, working in the hospital made me realize: I DO NOT want to become a nurse. Most of the nurses complained about their jobs, seemed bored, and I did not want that to happen to me. I want a fulfilling career that makes me reach my full potential in life. I didn't want to just settle.

So I decided to go back to what I really want to do in life: become a physician. I am really determined, and very excited, but it seems like everyone around me can't stop telling me how hard it's going to be.

I guess I'm writing this to ask for support and advice from mothers who went to med school with young children. My kids will be 5 and 3 by the time I start med school. Any support and advice is appreciated. And another question, did anyone with young children have anymore kids later on in life? I'm not sure if I'm okay with being done at 2.

Thanks in advance.

Monday, December 15, 2014

MiM Mail: Year off

Hi MiM Community!

I am in the middle of a year off, and at a bit of a crossroads. I got pregnant with my second child in the middle of MS2, took the Step 1 7.5 months pregnant (not recommended), and gave birth at the end of August. My school told me that I would only be able to take 6-8 weeks off max (8 was stretching it) if I wanted to continue with MS3. If I wanted/needed more, I had to take a year LOA and come back next July to start rotations with the next class. When I had to be off my feet during my 9th month, I decided to just take a LOA and enjoy my year off with my new baby and toddler.

I'm now 4 months into the time off and unsure what to do. I have been dabbling in continued research, but my heart is not as into it as I thought it would be. I do miss school and really look forward to going back and finishing, but all the plans I had for this year pre-baby (research, volunteering) just doesn't seem as exciting. Is it so terrible to just be a mom for a bit? Am I selling myself short for future residency applications?

I did OK on step 1. Not great, not terrible. I am not necessarily interested in a very competitive specialty, but I am very geographically limited (to basically the one big city I am in now) due to the abundance of family and support, and my husband's job. I know that this is my last chance to take my older daughter to ballet, join mommy groups, take my baby to music class, etc. Can I just enjoy my time without feeling guilty about not progressing my medical career? Or is that just not realistic and I should "get my act together?"

Thanks again for being an amazing community!

-Boxes

I am a MS3- to- be with a 2.5 y/o and a 4 month old. I love having an active lifestyle and looking for interesting things to do with my family around our wonderful city.

Monday, December 8, 2014

MiM Mail: Geographically-limited MiM applying to residency

Hi there!

I'm a mom in my third year of medical school with young kids, lucky enough to be going to school in a city with a lot of family help and where my husband has a great job. I've recently decided to geographically limit myself to my current city for residency, for the aforementioned reasons. Although we are in a big city, my chosen specialty only has one residency program with about a dozen spots (at my home institution). I will also be needing to apply for a prelim/transitional year of which my city has three programs. I think I would be a reasonably good applicant in my chosen specialty if applied broadly, however I'm obviously making a risky decision. That said, I'd prefer to remain unmatched and do research for a year or two than move us to a new city at this point while my kids are so young.

The residency program director at my school meets with all students applying to residency, and I would like to get some advice on how to broach with him the topic of only applying to his program. I have only met him once and he knows that I have kids. I want to avoid looking not committed to medicine obviously, and I know that I could be a great physician but being close to my parents/sibs for childcare help and not uprooting my husband and kids would be quite important to my overall success and happiness. Additionally, my dad has metastatic cancer and I know if I was doing residency in another city I would not be around to see him much. Any advice for how to approach this conversation would be much appreciated!

Monday, November 10, 2014

MiM Mail: Residency limit for leave and having children

First of all, thank you for this amazing blog that provides me with so much inspiration. It's so nice to hear from other women at all stages of training on their struggles and triumphs.

I'm specifically looking for anyone out there who had a baby during an anesthesia residency program. I'm hoping to have #2 while still in residency, but the ABA states that no one can take more than 20 days of leave per year during residency without making up the time. I know, based on my first little one (had during med school), that I will need at least 8 weeks, ideally 10. But I'm also poised to do a fellowship! Has anyone gone through this and found a loophole? Or convinced a fellowship program to let them start a month or two late? I feel that if we wait until I'm an attending, the age gap between our little ones will be too big (7 years).

Thanks in advance for your help!

Wednesday, October 29, 2014

Guest post: It takes a village . . .

...and my village includes a housecleaner, a nanny, a back-up part-time nanny for on-call days, an amazingly flexible husband who works from home and one amazing non-medical friend I've made in this new city. Plus, in really important crunch times, a family willing to fly across the country for weeks at a time to care for my family so I can focus on studying. I come from a family whose resources definitely did not allow for hiring nannies or housecleaners, so I always feel a little self-conscious about it and hesitate to seek help, even when I know it’s needed.

Before medical school, and even during the first two years, I could usually balance the work of school with the work of home. Between studying for Step 1 and then starting 3rd year, with two young children, I realized something had to give! I finally accepted the fact that extra help was necessary, for my sanity and for my success in medicine. While I don't mind cleaning the tub or mopping the floor, I would rather spend that time playing with my children, hanging out with my husband, trying to maintain some relationship with my friends and family, and of course, reading, reading, reading for school!

Since I've relinquished control of keeping up with the cleaning, and since my husband has taken over the cooking (mostly), I'm amazed how much time and mental energy I've been able to devote to school. I'm also pleasantly surprised at how much this extra time to study has boosted my confidence on the wards and subsequently my performance. Meanwhile, at home, I'm actually more likely to tidy up and clean a bit every day, since I don't feel so overwhelmed with the amount of cleaning to be done. This makes my husband, a neat freak by nature, extremely happy. Historically, every woman who could afford to hired people to help manage the house, so why do we try to be superwomen today?

I'm interested to hear how other mothers in medicine have found ways to expand their village of support and if they noticed a difference in their professional lives. I’m also interested to hear if you received any negative responses from your family about hiring help?

Ley is a medical student with two children under age 5. She lives on the west coast and remembers enjoying running, cycling and camping before medical school happened; she hopes to return to those hobbies sometime in the next decade.

Monday, October 20, 2014

MiM Mail: Respond to the itch?

Dear Mothers in Medicine,

I am a 29 year old single mother of 2 boys, ages 7 and 3. I'm not in medicine as of yet, but about 6 months ago started getting the itch that my calling is to be a Family Practitioner. I'm so glad to have found your site, as I am torn between following my dreams and putting my childrens' needs first. I wonder if anyone has advice - is there any way to do both?

I live near Cleveland, Ohio and moving isn't really an option (to my knowledge) since I am divorced and share the children with the ex 50/50 (I have them every other week). It also might be good to know that my 7 year old has ADHD. Some people consider this to not even be a true condition, I understand, but my child is severe and cannot even attend school without receiving his medication twice daily. I am really the only one who understands him and can give him the love he needs unconditionally. So I am definitely a huge part of his healthy well being. My younger son needs me too, of course, but is very close with his father. So I worry less about my younger son.

Currently I am a Sign Language Interpreter. For the past 11 years, 90% of my work has involved medical settings. So, I've had the opportunity to shadow just about every aspect of the medical field. It has been an amazing experience! And that's where the hunger to become a physician myself began.

I noticed that for just about any other foreign language you can find a doctor with whom to communicate directly, if you look hard enough. In Ohio, however, there apparently are no physicians fluent in American Sign Language whatsoever. Because of my passion for the deaf community, this saddens me. Even with extremely skilled interpreters facilitating doctor/patient communication, I truly feel that some (possibly cruicial) nuances of the language are lost in translation. I want to close that gap in patient care. We really are behind the times in this, as a society.

Other reasons I long to enter medical school: I have a strong passion for the sciences, math, and especially solving mysteries. What better mysteries to solve than those which could save or better someone's life? I was standing outside a patient room in a dermatology office and happened to overhear the conversation between the attending physician and one of the residents there. I immediately saw myself on both sides of the conversation - first as the resident, sharing the information I had gathered from the patient with my attending and gaining confidence in my abilities to correctly diagnose and treat each issue, taking into account the special circumstances of each individual patient. But I could also see myself as the attending physician. I know I would love using the leading questions to help new doctors grow and learn in their profession. I can see myself there, as if it is as close as tomorrow.

Now, I don't know if my background will be a hindrance, as I was home schooled, and only have my Associate's degree so far. I pressed forward and earned my degree from a local community college despite my family's protests. My family is very grass roots and took offense to me wanting to go farther in my education than anyone else in the family ever has. But I did it. I am a very determined individual, so I know I could get through medical school. Afterwards, I would strive to be the very best of physicians by always being willing and ready to learn everything I can - never being satisfied with my current knowledge.

So I guess what it all boils down to is this: Would it be possible for me to be a medical student and a good mother to my two children? I know my life will never feel complete if I don't reach my full potential educationally/vocationally, but I don't want to ignore my childrens' needs either, as my parents did. They should come first.

At first glance it might be easy to say, "Well, its too much if you have children. You'd never see them," and that might be the bottom line. But currently, my income is barely enough to survive. Being a med student would actually increase the funds I have to use throughout the year substantially as compared to working all that I can currently.

So I'm just looking for options and advice. Is there a way in Cleveland to be a part-time med student, perhaps? Or set your own schedule somewhat, since I have every other week without the children?

Thank you so very much for your time and consideration. I truly value any gems of insight you can provide.

Sincerely,

Torn

Tuesday, August 19, 2014

MiM Mail: Two parents in residency possible?

Hello! I am a pre-medical student and wanted to share with you how much your blog has comforted me about my future in medicine with a family. Although I do not see kids in my near future, I have been with my boyfriend since freshmen year of high school and am confident that we will end up married (side note- he is also pre-med). I am one of those people who needs to have all their ducks in a row, so to say. I obsess over the future and planning, which I know is not always convenient when it comes to both motherhood and medicine. Upon looking for advice about when the best time to have children was in the medical career, I found many people who said that it was best to give birth during medical school. This just seemed extremely difficult to me because there is so much studying that needs to be done, and I don't want to add years to my training as I plan to do a general surgery residency and then continue to specialize for about another 4-5 years afterwards. I went on to search for advice/experience from women who were juggling babies and residency, and that's when I found your blog! It has been immensely comforting to read from women who have made it through and to not have to read comments from male doctors that "a woman should either be a mother or a doctor, because each one requires 100%" (seriously, one doctor ranted about this on a discussion board, but failed to explain why it was okay for him to work full-time and barely see his kids just because he was a male...)

My boyfriend and I are the same age, so we would be in the stages of our training at the same time....is it possible to manage children with 2 parents working in residency? (if it helps, he is interested in a radiology residency, although I know that both our choices could change over time). I know many of you have had such difficulties when only one parent is in medicine, so it scares me that my situation may be impossible.

Thank you again for writing such a wonderful blog for anyone interested in the medical field to turn to. I believe that as women we shouldn't have to give up what we love to do for our children, but I still want to be able to have a good relationship with my children. I realize my questions might seem premature considering I'm only pre-med, but the ducks must be in a row for me...... :-)

Thursday, July 31, 2014

MiM Mail: Time for a second child?

Hi there,

I've been enjoying and learning from MiM for several years - since before medical school and before I was a mother. So thanks for creating such a great forum.

Now I am a second year medical student with an almost-3-year-old. She is great. And for the most part, medical school is great. But that's right now. My husband and I have been through a lot in the last five years to get here. We've both gone back to school and dedicated ourselves to new and intense professional fields. These changes have required two moves. In that time we have also both had pretty significant medical problems that have since resolved, but that caused a whole lot of disruption and stress, including stress on our marriage. In my case, this lengthened the medical school process.

Things have finally settled down. My husband has recently found steady work that he loves and provides him exciting opportunities. And our daughter, almost 3, is thriving. And now I feel like I can fully enjoy her.

Some years ago I thought I'd be trying to get pregnant right now. I put that thought out of my mind as we worked through all our many challenges. But as things settled down recently, I started thinking about a baby. The timing of things are no longer what I'd planned. We could try to get pregnant very soon - in which case I'd take Step 1 very pregnant. Or we could wait another year. Another year means an almost 5 year gap between children. (I am trying to prevent another year of school, hence the timing constraints).

I think our daughter is ready now for a sibling. She is becoming independent, potty-trained, able to start to share, etc. And if it weren't for all the circumstances, my husband and I would be more than ready. But I am concerned about perpetuating that pattern of being in constant stress, in constant needs-only, no time for fun mode.

On the other hand, some of that is inherent to the early childhood period, even if we were not dealt a few additional challenges. We all have to balance family and career and if this time is not going to be great fun anyway - why not create another awesome creature while we're at it?

I worry about some of the details. Would being 35 weeks pregnant affect my ability to maximize my step 1 score? (I have lots of interests right now, including one that is very competitive). And would having a baby in early 3rd year be crazy? I was back at work with a lot on my plate three years ago. I know I can do it. But doing it while missing two kiddos instead of one seems worse.

These are all details. And big picture is that family is important to me. And living the kind of life I want to live and become a doctor (rather than living life to be a doctor) is important to me. But so is happiness. And I don't want to push myself and my family so hard we can't enjoy what we already have.

Thoughts?

Thursday, July 17, 2014

MiM Mail: Disclose family in residency applications?

Dear Mothers in Medicine,

I was so excited to have found this blog! What an inspiration! I'm a 4th year medical student with a busy little 12 month old. My husband is wonderfully supportive and great at stepping up and taking care of our son when my schedule gets crazy. To be honest, when I first found out I was pregnant I would have never thought that med school + a baby would be so doable (ridiculously hard at times, but totally doable). Sure, there were many times when I was ridiculously sleep deprived and didn't get to see my husband or baby awake for a day or two. And sure, there were several times where I spent my pumping session crying in addition to stuffing a sandwich into my mouth as quickly as possible. But I did it, and I *think* I did it well. I don't mind anonymously tooting my own horn on this one because I'm darn proud. This past year has confirmed that I'm on the right track-I love being a mom, and I love being in medicine!

I am now preparing to apply to residency positions. As much as I tried to like a field with more potential for control over my schedule (peds, PM&R, pathology?), I realized that I would never be satisfied if there wasn't a significant amount of OR time in my future. I even almost let a few of my attendings talk me into going into general surgery, but in the end I decided that my passion is for OB/Gyn. I'm struggling with this decision because of the many hours/days that I know I'm signing myself up to spend away from my family. My husband tells me that I can always quit and be a SAHM, but that is not my calling and I know it. I'm already feeling guilty about putting my career in front of my family and now I'm faced with the decision of whether to disclose in my applications that my family even exists! I've been told that when selecting residents, if two applicants are otherwise equal, they will pick the one without commitments outside of the hospital. It's illegal, of course, to base decisions on these factors, but it's undeniable that it happens.

I think I've decided to leave any mention of my family out of my personal statement, but there are many other areas in the application process where this information could potentially come out. There are two different areas for explaining any breaks and extensions of the normal 4 year track. I took a LOA after I had my baby. Do I just say I took a medical leave and not explain? Is this a red flag? (Is this going to happen again? What if it was a psychiatric reason and she's unstable? Etc) I have heard of people bringing their kids/spouses to interview dinners. Do I leave them behind? Not talk about them? Hide my wedding ring? How far do I take this? It just feels wrong to hide the two most important and influential people in my life. I used to think that if a residency program doesn't want me because of my family, then I don't want them. However, in an increasingly competitive market, it may be naive and foolish of me to sabotage myself by disclosing personal information that won't even potentially benefit me. It just all feels wrong.

Thanks!

Thursday, July 10, 2014

MiM Mail: Keeping the relationship strong and resentment to a minimum

I am a third year medical student who recently had a child and am starting back on the wards soon, after a lengthy maternity leave.  I experienced some of third year already (while doing rotations during my pregnancy), and I'm absolutely terrified about going back!  Nope, it's not about the rigors of the wards or balancing school and medicine (we have older kids so I've done some of that already).  I'm terrified of the resentment my husband is likely to feel while taking care of the kids for such long hours on his own while I'm away and also while I'm studying.

He fully admits that he felt some of that in my first and second year and knows he'll feel it again when I go back since the hours will be longer.  To those in med school, residency, and practicing--what did you do to keep your relationship strong when your spouse often feels like a single parent?  I plan to do as much household stuff as possible, find some extra childcare for a few hours on the weekends when I have tougher rotations, try not to complain, and try to book family time for at least a little almost every weekend.  Any other ideas?  What works for you in this regard?  Thanks so much for any advice you have!

Tuesday, July 8, 2014

Guest post: Pregnant during residency (and not feeling the love)

Prior to becoming pregnant I thought there were no women's rights issues in today's day and age. It was only after I became pregnant that the struggles became all too real. One of the first questions I received from my program director upon announcing my "good news" was...will you take all 6 weeks? Soon afterward a colleague proudly told me he once worked with a resident who was back to work 2 days after delivery. He was hoping my pregnancy would be uncomplicated so I could do the same. Approximately 25 weeks into my pregnancy my physician said I could no longer work solo 24 hr in house calls or 80 hr weeks and that although I could continue my rotation duties, hours should be limited to 12 hr shifts, 5 days a week, maximum of 60 hours. This restriction came after early contractions, shortness of breath and tachycardia had set in.

Although my colleagues weren't pleased with this decision, they agreed to accommodate me of course with the assumption I will be heavy back loaded on calls when I return from maternity leave because each and every hour of call I miss needs to be made up. Made sense to me since caring for a 3 month old should be easy peasy right?

In the meanwhile I continued to work, study, do research, present at national meetings. Pregnancy brain hasn't always helped while being pimped or taking my yearly shelf exam but I have dealt with it as best as I can.  After receiving  two offers for prestigious interviews at two of the top programs in the US for my subspecialty my program director kindly contacted me to recommend that I not go to these interviews and postpone them in the interest of my health and since my schedule was already so "limited". I thanked him for his concern but went to the interviews anyway while 29 weeks pregnant and was accepted by both, able to have my choice!

Now with only 4 weeks of pregnancy left, my physician has recommended no more calls. I of course have worked with my colleagues once again getting them to cover my remaining calls with the promise that I will owe them all back.

I feel a bit like an outcast of the program right now all because I am trying to balance work with a future family. I hesitate strongly to say I am discriminated against but in some senses, I can't help but feel this secretly as well. I keep telling myself that this too will pass in hopes of things returning to "normal" after the pregnancy.

Has anyone else had similar experiences in pregnancy and if so, how did you deal with them?


-An ophthalmology resident