Guest Post: House of Cards

It really does take a village to get anything done.

I have a village all coordinated and well planned out to get done what I and my family need in order to get through each day. I even have decent scenarios for emergency coverage.

But not for tomorrow.

Tigercub 3 is feverish and needs to stay home tomorrow, again.

Nanny asked for tomorrow off a month ago for much needed personal issues.

Tigerdad will be out of town all day tomorrow from sun up to long after sun down.

And I have a weird thing on my skin and managed to get a coveted dermatology appointment for tomorrow afternoon perfectly timed for after my patients and before I have to pick up the cubs at school. Why? Because their blessed school has last minute after school coverage available.

But only for healthy cubs. So who can look after cub 3?

Mother in law can only cover part of the day.

My mother cannot do any part of the day.

So what to do?

Cancel all of my patients, of course.

And take the cub with me to the coveted derm appointment.

-Tigermom

Cross-posted at www.twowomenblogging.blogspot.com

MiM Mailbag: Family Dinners?

A study just released by the National Center on Addiction and Substance Abuse at Columbia University found that teenagers who have infrequent family dinners--less than three a week-- are more likely to drink, smoke, use marijuana and be able to get prescription drugs within an hour.

 Are they a priority? Why? What extremes do you have to go to make them happen? If you can't pull them off regularly, do you feel guilty or defensive?



A reporter is interested in speaking with working parents of tweens and teens about family dinners. If you would like to be interviewed about your experiences, please email us at mothersinmedicine@gmail.com.

Flu shots

We took Melly to the pediatrician to get her flu shot today. I am absolutely insane when it comes to flu shots. As soon as September comes, I'm immediately looking around for my flu shot. I got an email at work saying that the flu shots would be available soon and I immediately sent back an email, saying, "Where? When will they be available? FOR THE LOVE OF GOD, WHEN CAN I GET MY FLU SHOT??" They emailed me back, basically telling me to chill out.

So anyway, we were planning to take Melly to the aquarium today and got her all excited about it, then realized we had made an appointment for the flu shot today. Oops. So instead, we got her all excited about going to the "doptor." She hasn't been to a doctor in such a long time, I don't think she realizes that it's not something to get excited about.

The thing that made me nervous was that she knows Mommy is a "doptor." So I was really scared that when she got her shot, she was going to make that horrible connection and think that I was some sort of Mengele-like figure who was sticking needles in defenseless children all day.

So we got her into the room to get her shot. The nurse came in and with the needle and said to Melly, "Look at Mommy."

But she didn't look at me. She looked at the needle, fascinated. She looked at the needle as it went into her arm and the nurse injected her and then put on the band-aid.

And wouldn't you know it: NOT A PEEP.

In fact, she was totally excited to get the band-aid, then a second shiny band-aid for the cut on her knee, then an Elmo sticker. I thought she was going to freak out any second, but she left that office super-psyched about her Elmo sticker. I feel like she must be the first two year old in history not to cry during a vaccination. We both hugged her and told her how proud we were of her.

I kept thinking about how she watched that needle go into her arm with such fascination, and on the trip home, a thought suddenly occurred to me:

Me: "Melly, do you want to be a DOCTOR when you grow up?"

Melly: "No."

Oh well.

Welcome to our MIM Childcare Topic Day

Topic days are days on MiM devoted to a single topic, featuring posts from many of our regular contributors as well as guest submissions. Today, the topic of the day is Childcare. We're writing about daycare and nannies, costs, wait lists, dreams and nightmares. Posts are scheduled throughout the day, so check back often!

Thanks to everyone who contributed!

Scroll down to find the posts...

Third time's a charm...Tempeh's 11th hour topic day post on childcare

I always remember Topic Day at 11pm on...Topic Day, so here I am, dead last.

Wow, I could write thousands of pages on this one, but since it's late and I am leaving for work in t-8 hrs, I'll focus on the nanny issue.

We started out with my firstborn in a reputable traditional daycare down the road from our house, which is about 45 minutes away from our jobs. With no traffic. That lasted all of 7 weeks, during which time my son (a winter baby) was sent home for three distinct infectious illnesses. When he started there, I was an oncology fellow and my husband was an internal medicine resident doing his ICU rotation. When we would get the alarm bell that my son had a fever of 101 and needed to be picked up within the hour, it was a panic to figure out if we could even GET THERE in an hour if we dropped the chart in our hands and ran. Not to mention that you really can't just leave as a resident or fellow. It was constant stress. When I walked in to pick him up one day unexpectedly early and found him lying on a mat on the floor crying while his "teacher" balanced her checkbook, that was it. I took him home and we never went back. Thank God it was a Friday!

After I finished crying for about 12 hours out of guilt over leaving him there, we called my mom to come and contacted a wonderful local nanny agency. In our desperation to find someone to watch our son in our home ASAP, we tried to persuade ourselves that her references, who said our nanny-to-be "was more emotionally needy than our preschool aged kids" and "left us abruptly when we told her we were pregnant with a second child," must have had an axe to grind. She was kindly and at ease with our almost 5 month old son, and he seemed to take to her even at the interview. SOLD! Within a few months, she self-referred for PT for "the earliest signs of carpal tunnel syndrome" and started scheduling her PT appointments during her work hours because that was the time slot her preferred therapist in the practice had open. It would often take me an hour or more to get out of the house in the morning because she wanted to talk about some, usually quite minor, mishap in her day. Invariably, she would cry and want hugs--like actual hugs--which I would patiently deliver day after day while watching the minutes of my already very short workday (the fact that we decided to hire her only 26 hours per week will be a topic for another time) tick down over her shoulder on our kitchen clock. When we unexpectedly got pregnant with our second child when our son was 9 months old and shared this news at about 20 weeks gestation, she told us the following morning that she was quitting due to her worsening carpal tunnel and was gone a week later. She did stop by a couple of months later reportedly just to say hello. I noticed she was still wearing her splint. She told me that she missed nannying and had just come from an interview with another family who had one baby boy and lived just a few minutes from us. That was what had made her think of us. They called for a reference shortly after she left. When they asked why she had left us and I mentioned that her carpal tunnel had gotten worse, the mom said, "What carpal tunnel?" I asked whether she hadn't noticed the splint. Turns out she wasn't wearing the splint at the interview. The mom mentioned that she was almost 40 and wanted to try to get pregnant with another child within the next few months. My advice to her: "Run! Save yourself!" Lesson 1: Believe the references. Nanny history repeats itself!

For our second nanny, we decided that it wasn't worth paying the steep nanny agency referral fee a second time. We used an online DIY type of nanny agency called enannysource. It let us post a family profile with as much or as little detail about our family and our needs as we wanted. And we could search nanny profiles by the same details in our zip code. Like magic, a 36 yr old woman, the mother of a 9 yr old boy, saw our profile and emailed us to express interest within 24 hrs. She came to interview the following day. She had a degree in early childhood education but had never worked because her son was born shortly after she graduated college. She had gotten divorced due to marital stress over her son's medical issues (he was deaf, bipolar, and on the autism spectrum) when her son was a toddler and had remarried within the past few months. She was young, energetic, direct, and clearly a very devoted mom, which I thought would bode well for us since we were hiring her to be sort of a part-time mom. We were a little worried that her son's issues could cause her to be pulled in two directions, but what mom isn't? So we put it out of our minds. We needed a nanny, and she was otherwise perfect. I was visibly pregnant with my second child, which did not daunt her one iota. Ahhh, I thought, she'll stay with our family forever. So we hired her. Flash forward a few months, and there we were: scrambling to get home over and over because her son needed to be picked up from school or because he had a doctor's appointment or because his school was closing early for snow, etc. All reasonable, all issues we ourselves faced as parents. We felt like hypocrites to say anything about it. We knew how hard it was. A few months later, I gave birth to my daughter, and she fell madly in love with her. So in love, in fact, that she decided she actually wanted one too. Six weeks later, she unexpectedly dropped in at dinnertime with her husband and son to tell us that--GREAT NEWS, YOU'LL NEVER BELIEVE IT!!--she was about 1 minute pregnant, and they were over the moon. The next several months were a marathon with hurdles--morning sickness that made her unable to stand the smell of our kids' diapers, insomnia making her emotionally unable to deal with our tantruming toddler and colicky daughter, and ultimately, the deal breaker, back pain that got worse with having to carry our kids around. Lesson 2: If your nanny has kids of her own without iron-clad childcare, and you/your spouse don't have a VERY flexible job, you are in for trouble. Lesson 2, subpart 1: It may be illegal to ask a nanny of childbearing age if she plans to get pregnant (unless she brings up the topic first), but it's not illegal to talk about it at night in bed with your husband if your nanny candidate is in her late 30s and newly married. Especially if you have or are about to have a delicious little newborn who could plant such a seed in her fertile brain.

For nanny #3, we again went back to enannysource. This time, I was wiser. I spent hours and hours every night after our kids went to bed sifting through nanny profiles, word-smithing our family profile, reading between the lines both ways. It took us almost 5 months to hire our next nanny during which we officially used up every favor we were ever owed and got a 40 yr or so advance on future favors with our parents, siblings, friends, and a few babysitters turned temp nannies where they were available. To say that it was stressful doesn't even begin to describe it. Fortunately, we had reached a point in our training when we had more flexibility so we could arrange to go in early and come home early and the other spouse go in late and come home late. It wasn't easy, but we made it work. When we met our third nanny, whom I had emailed back and forth repeatedly and interviewed by phone (along with dozens of others) for about 90 mins before bothering to invite her to our home, we knew that was it. She was 26 yrs old, single, energetic, had taught in the public school system but wanted to work with kids on a more individual basis, and she shared our values. Her references, which weren't really in childcare, loved her across the board. Over and over, they described her as loyal, reliable, honest, flexible, optimistic. Music to our ears. Our only reservation was that she was kind of...well, sloppy. But, we said, we can live with that. And when she described what she had done with kids at an in-home daycare she had worked at several years prior, we noticed that all of the activities sounded like...well, a huge mess. We had a moment of reservation as we surveyed our light carpet and pastel-colored sofa and chairs, but, hey, kids are washable, and that's the fun of being a kid. Our shy then 2.5 year old son kissed her goodbye at the end of the interview! We hired her. That was 3+ yrs ago, and she has been an absolute joy to have in our family. She loves our kids, makes them handmade gifts for every birthday and Christmas, remembers my son's Epipen and chases me up the driveway with it when I forget, and is more patient and creative than I will ever be. She even makes us dinner when she knows we are going to come home exhausted, which is more often than not. She joined the Y so she could take our now third child, who is a complete water baby, swimming while the older two are at kindergarten and preschool. She is loyal, reliable, honest, flexible, and optimistic. Our only complaint: she's...well, sloppy. And the things she does with the kids--things like painting refrigerator boxes with non-washable tempera paint on our kitchen floor--are...well, a huge mess. But, hey, we can live with that. Lesson #3: Trust your instincts. Know the things that are deal-breakers for you. And the things that aren't. And see lesson #1!

Which reminds me, A, that you deserve a raise!

Admitting I need help

I recently let me my nanny of four years go, just after having my third kid - yes, I know it sounds crazy but I was having an identity crisis. I decided to take an extended leave from work to enjoy being 'mom' and I was sure that with the older kids (4 yrs and 2yrs) being in school half days that I could manage without help. I've always thought that I can do more than what's normal, in fact, now that I think about it, I think I define myself by being able to go 'above and beyond the call of duty'. Well, sadly I was wrong. I struggled through two months of life with the three kids and found myself tired, disorganized, snapping at my kids, craving time with my husband and over-using my Mom for help.

I've finally come around to the conclusion that it's precisely because I want to be a great Mom that I need help at home.

The challenge is not just finding one, but also managing one. I had a nanny for four years and despite my ability to manage difficult patients on an internal medicine ward, challenging residents in a large academic program and three kids with all different needs (well 4 kids if you count my husband), I find that it is the most challenging to manage my nanny. I realize now it has a lot to do with mother's guilt. I just do not want to see my nanny as an employee, a housekeeper or a babysitter. I want to see her as an extension of myself so that I can say to myself, that my kids are in good hands. For a long time I had a problem with the thought that the same person who would look after my kids would clean my bathrooms - so for a long time, I didn't ask my nanny to do anything but look after the kids. But this meant that when I would come home from work, I would do all the housework while she continued to play with the kids - something is wrong with that picture!
So as I now look for a new nanny, I have come to terms with the fact that firstly, I need help and second, that I need someone who will look after my kids AND my house. I met a family today visiting from Pakistan. The Mom had 3 kids exactly the same age as mine and she said she doesn't know how I do it - because where she lives, there is so much help - for the house and for the kids. She said, where she lives, it's easy to have three kids! After meeting her and after a long few months without help, I now can comfortably say that I need help with both my kids AND my home.

I put an embryo on a daycare waitlist

September 2001

One year and three months into a two-year residency, I give birth to my daughter. I am eligible for one year of maternity leave, and have every intention of staying home with my sweet, big-eyed Saskia for all fifty-two weeks.* Pete and I haven't yet decided what we'll do for childcare when the year is up, but daycare isn't even on the table. I grew up understanding that daycare was for the unfortunate children of selfish mothers. It was fact, just as neighbours who mowed their lawns on Sundays could not be Christians.

January 2002

I sit at the desk in our loft, looking at a list of home daycares. The nine remaining months of residency loom over my days with my infant daughter. I have an irrational fear that I will have a series of consecutive pregnancies - defying all contraceptive measures - causing a perma-maternity leave and precluding any possibility of ever finishing residency. I am desperate to be done with it.

My residency program agrees to my request to return half-time, five mornings a week. We have no family nearby, a nanny seems like overkill and I am prejudiced towards group daycare, so in-home daycare seems like the best option.

Saskia lies on a blanket on the floor next to my desk in a fuzzy purple sleeper, arms waving, and as I dial the first number I feel sick to my stomach. It remains one of the most profoundly distressing moments of my life.

I dial and wait for the kind voice of soft, grey-haired caregiver. A man answers instead, hands the phone to his wife. I can't do it. I imagine my daughter in a stranger's basement rec room, husband and teenage sons coming and going, and I hang up.

I resort to calling institutional daycares. The only one that has an opening is attached to the local high school and cares for the infants of teen mothers so they can stay in school. I take it.

February 2002

It is a relief to be back in residency, end in sight. I love immersing myself in medicine again, and trundling Saskia home in the stroller in the early afternoon is ideal. I do have some anxieties. After the first week of daycare I marvel that she hasn't been abducted from the centre yet. Somehow it seemed that the moment she left my arms she would be in imminent danger.

Months later, a video of the daycare is shown at a gathering of Vancouver's who's who to raise funds for the support of teenage mothers. Several physicians recognize me in the footage and are confused.

Summer 2002

I've waitlisted Saskia at all the best daycares in Vancouver. A spot opens up at my top choice, a daycare attached to a hospital that has an infant, toddler and preschool division. Now I sign in Saskia and hang up her poncho alongside colleagues in medicine, research and physiotherapy instead of fifteen-year-olds.

We bring Saskia every day to energetic ECE-certified women who love their jobs. The child-teacher ratio ranges from 1:3 in the infant room to 1:4 in the preschool. Daycare doesn't call in sick, move out of town or take vacation. Saskia thrives and we are relieved and grateful.

2003

I finish residency. We reduce Saskia's childcare to two days a week and I work part-time.

I conceive and put the embryo on the daycare wait list. Eight weeks later we announce the pregnancy to our parents.

Spring 2005

A spot opens for my three-month-old son, but he's not eligible to attend until he's six months old. To retain it I pay full daycare fees for those months. I am ashamed that we resort to this, but it's common practice in daycare situations and the truth is, we'll do almost anything to get and keep a spot in a daycare with over eight hundred families on the waitlist.

When Leif finally joins the daycare, his caregivers in the infant room are the same ones that cared for my daughter three years ago. There has been virtually no turnover. They love him as they did my daughter.

Summer 2006

We move to Deep Cove, a half hour away from the daycare, and don't even consider changing our charmed childcare situation. Daycare close to work is much more convenient that daycare close to home, anyway.

I have my third child, Ariana, and we repeat the embryonic registration and retainer fee scenario that occurred with Leif.

September 16, 2009

My two oldest are in school, and Ariana still attends the same daycare two days a week, taught by the same teachers that cared for Saskia and Leif. I've been buzzing myself through that red front door with a little backpack on my arm for over seven years now. It's a comfortable part of our routine. So comfortable, in fact, that - behind on laundry this week - I sent Ariana to daycare in a pair of her brother's briefs, knowing I wouldn't hear a whisper of judgment.

* I am Canadian

Drop offs and pick ups

Day care, preschool, kindergarten, after hours (and before hours, which we have not yet needed)... it is almost too overwhelming to reflect upon. We've been fortunate to have had very caring providers, some smart, some funny, some artistic, some traditional, and most of all interested in the growth, development, and well being of our kids. Perhaps it is my hypothetical pink contact lenses which make the situation seem so rosy, ultimately along the lines of "it's got to be good" because we didn't have too many other options! Initially no relatives nearby. And our being a Mother and Father in Medicine.

I did two years of drop offs and pick ups when Now Five was our Only, and in a day care center right next door to Mommy's work. It's coming back to me now, indeed I could not contain myself, literally I could not stop bawling when I visited the center, the week prior to the very first drop off (that was over 5 years ago!). But my huge outpouring of emotion (so many tears I could have dehydrated myself) was therapeutic and allowed me to feel good, subsequently, in time. Breastfeeding and providing pumped breast milk helped maintain our special bond.

Two years later along came her brother and a new job for my husband, and a fabulous new daycare ("school") for both kids. NAEYC accreditated and all that jazz, and it was jazzy in a low key sort of way. From that point on my husband became the main dropper offer and picker upper since it was next door to Daddy's work. Though I made sure to pick up at least twice a week so I could see, help, do, share.

I remember fondly those child care providers who were easy to talk with and be with, who gave me unsolicited pictures of my kids caught in the act of having fun, who taught me things (any interest in "stool withholding" for another topic day???), who taught my kids. Early lessons in social interactions. Early lessons in graham crackers and not having peanut butter. Other lessons like sharing is good, but it's not good to share your lunch (again, it may have peanut butter in it!). And, alas, the other less interesting providers do not loom large in my memories.

There were the many opportunities for field trips, some we could attend, some we heartbreakingly (ours and theirs) couldn't. And the performances, school birthdays, and holiday parties. International Day, fire drills, Music, Dance, even Yoga, all at the day care. And the fevers (fortunately few and far between) and the rare snow days. Enjoyed many of the other parents too (good thing, since birthday parties are with parental accompanyment at these early ages).

Never picked up too late, officially speaking, but then again, sometime not quite early enough. Often late for work, but that's the new normal. And did some "work" at daycare, discussing pediatric matters and other practical medical advice when asked.

Was it all rosy? At least the least desirable aspects have become funny with time. And eventually, you rush out of work and in traffic to pick up and find your little ones immersed in an activity, oh so important that you could come back in a few, take 5. Did I wish they weren't at day care? Not once I saw how much enjoyment they got from the interactions with their peers and teachers. Did I sometimes wish they weren't there for so long in the day? To this I'll admit. But then that's where the skipping out early and catching up on things after they go to bed comes in. Late bedtimes for napping daycare attendees and working parents, that's another story. Zzzzzz

Days and Days of Day Care

It is amazing to see the variety of available child-care options that are available to working parents. For our family, we carefully considered all options when I was pregnant with CindyLou. I was a resident, with very limited maternity leave (unless I wanted to prolong my residency training...I didn't) and my husband was moving up in the finance industry. We had no family immediately available, and, I am not sure if I saw one too many "Hand That Rocks the Cradle" -type movies, or what, but I was not comfortable bringing a stranger into our home to raise, shape, and mold our precious young child. What can I say (the lady tried to *breastfeed* that kid!!!)? I'm an alarmist, but Mr. Whoo felt the same way. So, we settled on out-of-home care, or, the dreaded "day care." I felt that the group setting held certain safety and social advantages over home care. For us, looking at certifications like NAEYC helped us to stratify centers, then we carefully would visit and observe. CindyLou's first day care was in a church-run facility. They had NAEYC accreditation, individual door codes for each child and family, and an "open door" policy. We loved the staff, and, as much as a small infant could, CindyLou thrived there.

After residency, we completely lucked into a top-notch facility, meant mainly for government workers, but they would sometimes open slots to the slovenly masses if they moved far enough down the food chain. This place was like Fort Knox, and you needed 24 hour security clearance (with armed guards at all entrances to the property) just to get onto the campus. Needless to say, we felt she was safe there. In addition, we were really impressed with the facility, staff, and, get this, curriculum. Who knew that day care could have a *curriculum?* We fell into the habit early of calling day care "school" and her care providers her "teachers." She was learning so much, it was easy to do. Socially, we felt that the exposure to different children and personalities was a plus for our outgoing child. Academically, we felt she was always challenged and she came home talking about things that she had learned we would have otherwise thought beyond her level. There were daily progress reports and periodic "parent-teacher" conferences. We always felt well informed about her day to day life in "school." Some downsides were the strict regimentation of protocols, and, as a Gubment agency, an inordinate amount of "days off" that were not necessarily days off for me. Fortunately, once the Bean came along, siblings were given priority, so he was also placed in the same center. We never felt badly leaving them in the care of the staff of the center, and over the 4 years we were there, they, the other parents, and other children came to feel like more of a family. It was a sad day when we had to leave them.

Now, here in Newville, CindyLou is in Kindergarten (for which I feel she was well prepared due to her day care "curriculum") during the days, and after school goes to a private program in the same pre-school in which the Bean is enrolled full time. In her after-school program, she has structured homework help, a place to go on those odd "holidays," and, in the summer, a fun, camp-like experience with lots of activities and field trips. This facility prides itself on being called a "school" rather than a "day care" so it gelled well with our overall philosophy. However, it is quite a bit more expensive (to the tune of $300 extra a month, and that is without CindyLou being enrolled as a "full time" student), but we can also attribute that to the area of country to which we have moved.

After several unstructured weeks off, and being out of the routine, the structure of the school-like environment was a welcome change for all of us. After a week or so of separation anxiety, we have finally gotten back into the daily groove. Bean can't wait to tell us each day how he loved reading books, playing outside, Spanish class (!!), and, most of all, playing with his friends. So, for us, careful research and quite a bit of good luck have lead to an all-around favorable experience with out-of-home care. For our family, the social interaction, structured learning, varied daily experiences, and caring staff members have made leaving our little ones behind as we make our way in the world just a bit more bearable.

Flexibility is Key: Change is OK

The take home message from the following, for those who don't have time to read the whole post: Don't be afraid to change childcare when your child's needs change...or if your care provider pisses you off. We've been flexible, and that has served our children well.

When Son was born, I was a resident and husband traveled most of the weeks of the year. I needed flexible child care, but we couldn't afford a live-in. We chose Lourdes, a wonderful grandmotherly woman from Ecuador who lived just a few blocks from the hospital. She had watched my niece and we were comfortable with her.

She spoke Spanish in her home and spent 99% of her day holding our baby. Whenever I picked him up, he was clean because she and gave him baths several times a week. When Daughter came along, I couldn't believe how much I had to bathe her. I didn't bathe Son more than a dozen times in his first two years of life.

I could call her at 6pm and tell her I had a patient in labor and wasn't sure when I'd be able to pick Son up and she'd say, "Mamacita, let me keep him overnight...please?" We never did that, because we are lucky to have so many friends and family members who would pick him up in our absence.

When he was two, we clearly saw that Lourdes was more a "baby" person than a kid person. We wanted a bit more structure. We switched him to a highly recommended preschool near the hospital. The owner, a Russian immigrant, ran a very, very tight ship. Son spent a lot (a lot!) of time in "time out" but seemed happy overall.

I, however, needed to grit my teeth and practice deep breathing when the teacher would critique my parenting in front of him, other children, other parents. I tolerated it because it was better to keep him in one place than to move him again. She saw every one of his age-appropriate rule infarctions as evidence that I, a "woman doctor" (which she said as though she was spitting the words) did not spend enough time with him.

Finally, after he had been there about 18 months, I asked her for a note of support for our adoption home study. She told me in front of Son that she couldn't recommend we bring another child into our family to neglect it like we had Son. That was it. We gave our notice and moved Son to my new hospital's award-winning child care center.

Having Son, and then Daughter, at the hospital was a dream come true. I occasionally wandered over to the center after lunch to say hello to them then went back to complete my rounds. Alas, the job ended (and for that I thank God on a daily basis!) and I couldn't leave them there.

We moved Son to a new preschool. He actually attended the first day it was open. It is run by a PhD in early childhood education who hires only teachers with baccalaureates in some related field - music, teaching, psychology. It is across the hall from an autism training center, and part of each day the regular kids and the autistic kids get together for activities. The new school is very small and currently there is a 3:1 child to teacher ratio any given day. When Son goes to kindergarten next year, he will benefit from the intensely individualized curriculum at this school.

Daughter, on the other hand, is too young for Son's school, though she'll start there when she is 2-1/2. Until then, she is happy in the home of a neighbor who runs a licensed child care. Daughter is one of five little girls under the age of 4. Our care providers (the neighbor and her sister) love her as though she is their own. There are plenty of toys and the environment is safe. We feel good that when we drop her off, she reaches out for these women, and when we pick her up, she reaches out for us.

We are, after all, the real constants in the lives of our children. We will never leave them, and we feel confident that they understand that. With my new job and husband's now-reduced travel schedule, we are usually home together with the children by 5:30. Will they remember the changes in their care providers? I doubt it. Will they remember that we were always there for them? I certainly hope so.

Guest Post: I was the nanny

She was an OB-GYN just beginning her new attending position in private practice as child #3 turned 6 months old. She left her beautiful baby girl and sons 5 and 7 in my care while she went to work. Her husband was amazing and he helped out with everything, often dropping the boys at school or coming home early to take sons to sports practice and appointments, etc. But three kids is more than one person wants to feed, dress and arrange play dates for so this is where I came in. I was not the first or last and at times I was not the only, but for a year I was the primary nanny. I didn’t live in, unless she was on-call or he was out of town but I did breakfast duty to night times stories and sometimes both depending upon the day. It was an amazing year. I learned a lot about medicine from her view and I got to play house and decide that I did want it all, a family and a career in medicine. For over a year I watched her kids grow up while she worked at a job that I knew I someday wanted. At the end of the day she would come home and all three of her children would rush to the door or call for her. First she would wash her hands (I always thought it odd that she didn’t do this before leaving the hospital or office but I suppose she wanted to get home as fast as she could.) She might miss dinner but she would almost always be home before bed time to read stories with her sons or breast feed her baby girl. Later she would tell me about her day, the hard case or difficult patient and I would tell her about homework and play dates and new milestones. She was an amazing mom yet obviously loved her work. I was a part of their lives and often wondered if/when I would fit a family into a medical career. I am now a medical student (and married to an OB-GYN resident) and haven’t yet figured this out. Currently I’m in a different country then my husband so children are not on the horizon. I not sure when/how we will start a family but I know it is possible, because I follow your blog and because once, I was the nanny.


About Me: Right now my life is all about neuroscience, physiology and immunology as I’m in my 2nd term of medical school on a little island known for its spices and beautiful beaches. I keep a blog of my adventures: http://notesfromspiceisland.blogspot.com/
My dream is to practice pediatric neurology and hopefully I’ll figure out how to rig my biological clock so I can have a family once I finish this whole MD training thing.

Best decision made

I was recently at a birthday party for one of my husband's colleages (who is a doctor). It was one of those events where I didn't know the majority of people there and I had Anesthesioboist's post in my head about female physicians and friendships as I entered into conversations with other women there. I never offered up that I was a physician off the bat, but as it came up naturally - someone asking me what I did - I told them.

I was talking with one woman who told me - out of the blue- that she was a doctor. Then, she was quick to add that she doesn't practice. She completed a residency, but then had two children and decided she couldn't go back to work. The main problem for her was not having a childcare situation that she was happy about and not feeling like she had any other choice. She asked me who watched our children and I told her about our amazing live-in nanny who has made our lives so much easier. I mean, it's a tremendous difference. She felt that she would actually have stayed in medicine if she had such a childcare situation.

I never thought I would ever be comfortable having someone, a stranger, live with us and help take care of our children. Yet, since last fall, we've had R here and let me tell you, it is incredible. She is wonderful with the kids, does our laundry during the day, does light housekeeping, and *whispers* she cooks dinner for us every night. It means that after a long day at work and a grating commute, I can come home, put down my bags, and play with my kids until dinner.

This is in stark contrast to the live-out nanny we had when my daughter was little. M was a constant source of stress. She was always late, emotionally unstable (I arrived home one day to find M sobbing on the stairs and my daughter, sitting on the stair below, playing.)-- we were always waiting for the other shoe to drop. This is not to say that there aren't wonderful live-out nannies, or that live-in nannies are necessarily better, but we've found a situation that works for us. My husband and I are constantly thanking our lucky stars to have found R - hands down, one of the best childcare decisions - no, life decisions- we've made.

R is like a part of our family now. Our children love her. She not only buys them gifts out of the blue, but has given me gifts too - just because. Sure, as her employer, I handle withholding, unemployment insurance, and health insurance, and it makes filing taxes every year a little more burdensome, but she is entirely worth it.

How did we find her? Would you believe it- Craigslist.

Please don't mention it.

The Day Care topic day is scaring me a little. Okay scaring me a lot. I am mother to a 9 month old. Since birth- well actually earlier- even in the womb my son was the happiest little baby. When carrying him, he was not much of a kicker. Granted on my feet running around all day it was hard to be conscious of his movements. I would lie in bed at night, holding my belly, waiting to feel him move. Nervous I would often put the heart echo probe on my belly, just to see the heartbeat. Turns out he is just an amazingly chill baby. Coming from a mother who is, let’s say less than chill, it seems to be a bit of a miracle. As a newborn he loved to sleep. He rarely cries. He loves to cuddle, giggle and follow the sound of the labradoodle’s jingling collar from room to room. My friends are envious of how “easy” he is. He makes us look like excellent parents. So, yep he is perfect and now it is in my hands not to screw it up! The fields of motherhood are treacherous. For this working mom no area more frightening than the topic of the care of my most precious during the day while I am at the hospital. It comes up all of the time. Casual conversation in the elevator, with patients who see me again after pregnancy leave, from colleagues with genuine concern. So how is it to be back to work? It must be so hard to be away from your son. Do you miss him during the day? Did you hire a nanny? Does he go to day care? No matter how I answer these questions I ALWAYS feel terrible. The honest truth? Maybe I was excited to get back to work. Maybe I am so engrossed in my patients my mind rarely wanders home. I must be a horrible mother. I must be a terrible human. Evenings and weekends we celebrate the little man. I am constantly observing his progress. He seems to be doing fine. So far. But I still worry. It seems that if my baby is happy, successful and loved it is good, right? Good enough?

Guest Post: Childcare from Hell

Once upon a time, before maternity leave was available, I had to return to my university clinic job 3 weeks after birth of first child. A home day care provider was chosen who had lots of good references. She was mid 50’s, her own children grown, with husband who worked as the maintenance engineer in a nearby condo. Only cared for two children at a time. The couple fit their roles well, except they lived in the condo instead of a double wide. She was overweight, teeth gone, smoked over a pack a day (but not when baby was there). His teeth were also gone, and he had a 2pack/1pack habit. (2 packs cigarettes/1 six pack beer daily). But she was a fantastic care-giver for a newborn. Content to rock the baby for hours a day, extreme caution and attention to safety, etc.

It was a dream situation for three years. Then, one day, day care provider found out maintenance engineer husband had been having an affair with the “dumb fat front office receptionist” as she phrased it. As soon as husband came into their apartment, with the two children there, she chased him around with a butcher knife threatening homicide. He left. I picked up son later, unaware of the drama. Later that evening she took an overdose. Local ER trip for stomach pumping. That’s when I was called by her daughter-in-law that I couldn’t bring son back in the morning. Next day, she hired a U-haul, loaded in all furnishings except one twin bed, one chair, and one cup, dish and utensil set. Even cut up the wall to wall carpeting to roll it up into the U-haul. And rode off into the sunset.

Grandparents were called into town until new arrangements could be made. Child was initially upset with new day care situation. But – he’s now an MD himself, and fantastic father to two toddlers. What can I say?

DR.NANA

Still figuring it out

We had my daughter midway during a two-year research hiatus from my residency. Our daughter is now five and just started kindergarten.

Because my husband and I both had flexible schedules for her first year of life, the two of us split our time with her for that first year. We then put her in a Montessori school when she was one year. We have been fortunate with this because she thrived and continues to thrive in that environment.

My husband gets most of the credit. He is the one who continues to take our daughter to school/camp/activity most mornings while I am already at work at some early hour. He is also there when I am on call or have an emergency in the hospital.

The other important thing that has made our lives easier has been his income, which even while I was in training made it so that we could afford her childcare. In addition to school expenses, we have also needed to have someone pick her up at the end of the school day (typically 4:30 pm) and care for her until one of us gets home (typically 6pm). We have achieved (in our minds) “equilibrium” with our daughter.

Fast-forward to now. I am at home on maternity leave with our 4-week old son. We are thrilled to have him – as we waited until I finished surgical residency training and fellowship and started practicing last year.

But as we have known for some time and now experiencing personally these past few months – the childcare process, particularly with infants, can be overwhelming. So far, our solution this time is a “patch-work” approach with the help of our parents who are not nearby. After the first 6 months, there is still more to figure out.

Our “patch-work” is something like the following: 2 months of maternity leave with me, 1 month with husband’s mother staying with us, 2 weeks of husband (delayed paternity leave), 1 month of my parents staying with us, 2 weeks of me (personal leave), one month of husband (delayed paternity leave).

Yes, my husband’s work offers 6 weeks of paid paternity leave, and he is going to take it.

I guess the lesson is that you have to be adaptable. And that resources and support help. But the process can be scary. Maybe looking at our oldest and seeing how things have worked for her has reassured us (perhaps falsely) that things will simply “work out” if we are diligent. We certainly hope that that is the case for this one.

Our Nanny - a true gift

When Eldest was born, I was still a resident. Our first attempt at day care was, in short, a disaster.

Despairing at our choices in traditional day care, we decided to look for a nanny. I signed on with a "nanny agency", praying that we would find someone suitable - and quickly. I still remember the first day we met Nanny. We had already gone through several interviews, and hadn't found anyone that we thought would work. Then Nanny walked in. She was obviously a little shy and self-conscious. She teared up when discussing the children she had cared for in her previous job, mentioning how much she missed them. Then, when Eldest toddled over for a closer look at her, SHE GOT DOWN ON THE FLOOR WITH HIM AS SHE WAS SPEAKING TO US. Her rapport with Eldest was immediate and obvious. For us, the decision was made at that moment. Was it the correct decision? I like to think so, as she was with us for more than 10 years. She was available if I had to work late and Husband was on a business trip. She was available on the rare weekend that we didn't have a parent or in-law to sit with the kids and we wanted to go out on one of our infrequent "dates". Although she didn't live with us, she probably knew my house better than I ever will. She still keeps in contact with my children. She was (and is) a phenomenal person. I fear that despite my attempts to thank her my gratitude has fallen far short of what it should have been. So Nanny, if you happen to be reading this, THANK YOU THANK YOU THANK YOU.

A

Too poor for daycare

I'm not one for shooting off numbers, but man, this is a story I can't help but tell:

We recently moved and had to give up our previous beloved daycare. It was a big sacrifice, but when the commute gets to be over a hundred miles, it's time to start looking elsewhere.

I started calling daycares in the vicinity of our new apartment and many of them were full. I started to have a panic attack. How could I go to work? What was I going to do???

Finally, to my relief, one daycare told me that although they were full, they might have someone leaving soon and could secure a spot for my daughter. I was so relieved. I started making arrangements. I casually asked them what the daycare would cost.

"Our tuition," they told me (I should have known there was trouble the second they called it tuition), "is $2400 per month."

I almost choked. $2400 per month. Almost $30,000 per year. For a two year old to sit in a big room of toddlers and color. Presumably she'd be coloring with solid gold crayons because I can't imagine where else all that money is going.

What baffles me is that they daycare was FULL. There were several dozen parents willing to pay this gigantic sum of money. Who are these people?? And what if you have two kids in daycare? That's nearly $60,000 per year just for daycare!! What sort of salary do you need to be making pre-taxes to pay for this? Each parent would have to be working and earning six figures just to break even with daycare and rent.

I did manage to find a daycare with a somewhat more reasonable "tuition," although still kind of horrifying. But now my problem is the hours. They close at 5:30, no exceptions. What sort of daycare is closed by 5:30?? How many working parents are there who are presumably earning six figure salaries to afford two kids in daycare yet can manage to be AT the daycare for pick-up by 5:30 sharp every single day?? Who ARE these people and how can I become one of them???

Guest Post: Loving daycare

I am an internal medicine intern (9 months of q4 to q5). We live across the street from our daycare. They open at 7 and close at 6 and Luke is generally there during much of their open hours. Since I am a resident, there are many days when dad drops him off and picks him up. I also made the decision to do a residency in the same town as my parents, so that they could help out when we needed them to. We also hire one of the workers there to give us a date night every couple of weeks. Many of my co-residents have nannies, but one plus of the daycare situation is that there are always at least two people watching our baby. And we have everything on video. Another plus is the cost, which is half of what it would cost us to hire a nanny.

We are loving the daycare situation. Both of us were daycare kids so we are personally aware of the pros and cons of daycare. He was 14 weeks when he started, though there are 6 week olds that start there. He is now 8 months old. We pay $800/mo for daycare, a price that decreases as the child gets older. Most good nannies require at least $10/hr, a fair wage if you ask me, but it would be hard for us to afford that with the money we are bringing in. I know people who went into (more) debt to pay for a nanny during residency. Also, there was no daycare at the hospital I work at. A few hospitals in town offer that, and we would consider that, but it is nice not having to drive the child to daycare. Our daycare offers 4:1 supervision, there are some in town that offer 3:1 but they cost more and there is a waiting list. We registered our child there when I was 6 months pregnant to be sure to get a spot. Most places will tell you how far in advance you need to register. I would do it while I was pregnant if you live in a place with relatively few options. Once we have more than one child, the nanny thing might make more sense.

Side note: we use the child care savings account so much of the money for our child care is tax free. Some of the tax incentives for childcare are income dependent and may best apply to those in residency or fellowship.

Another side note: How are you providing health care for your nannies if you have them? Seems like most of the ladies at the daycare where we send our child do not have health care. I think it is crazy that the person you have caring for your child wouldn't even have access to basic services. Anyone have thoughts on that? I am trying to get those who need it into our resident clinic, but it is not easy due to lack of availability.

Guest Post: A variety of arrangements over the years

We had a variety of arrangements as the kids grew up, some better, some not. When they were tiny we had a wonderful woman who came to the house. She took great care of the kids and also did all the laundry including cloth diapers (now I'm dating myself). Sadly, she did not come with us when we moved out of state (I tried). After that we had daycare, then daycare/at home combo where I hired their favorite daycare worker to bring them home early and start dinner (almost all of the workers were--just barely--part time so the centers wouldn't have to pay benefits). After they went to school we had after-school day care, and later after-school home care by a series of high school or college students. Said students also functioned as drivers for after school activities and worked for a longer day during the summers to drive to summer activities (I always had the summers pretty well planned by March). What I remember mostly, especially when they were young and got sick a lot, was that the whole thing was like a house of cards. If somebody woke up with a fever one of the cards came out and the whole thing fell apart. The chicken pox was a major disaster. Luckily I had a supportive husband and (in a pinch) a mother in law who was able to come help when things really got bad. It really was terribly hard a lot of the time and I doubt it's got any easier since. Like I told a younger colleague the other day, "eventually it does work out. They grow up and leave home."

-By a FP with grown children

Teachable Moments - do they come with a glass of Merlot?

“Mom,” Will says, “Harry carved his initials into the neighbor’s front door.”

Angel: He did what?!? No, it can’t be. That door is made of METAL.
Devil: That’s my boy! Metal, Schmetal.
Angel: How could my sweet, cherubic Harry do such a thing?
Devil: Hmpf! My cousin, Grover, sits on his left shoulder and talks really loud.
Angel: Hush! You’re not helping over there.
Devil: Just let it go – boys will be boys.
Angel: Boys will be juvenile delinquents, too. You need to call his father.

Phone rings…“Daniel, your son carved his initials in the Smith’s front door.”
“But, it’s a steel fire door. Have you seen it?”
“No, not yet, but he did it with a pocket knife.”
“Well, I think an immediate apology is in order.”

Devil: Oooooh! Now you’ve gone and done it.
Angel: He needs to apologize and offer to repair it.
Devil: Yeah. Can you imagine an eight year old repairing a front door?
Angel: OK, then he needs to pay for the damages.
Devil: You mean you need to pay for his damages.
Angel: Whatever. This is a teachable moment, and he needs to learn from his misstep. Besides, they’re trying to sell their house. Who’s going to buy it when they think their neighbors are a bunch of vandals?
Devil: You’ll never get him in the car.
Angel: Wanna bet?
Devil: I’m always willing to make a deal.

“Hello, Haley? Harry and I need to apologize for your door.”

Devil: Are you happy? You made him cry in front of the neighbor.
Angel: I know. I know. I feel like dirt. Parenting with a conscience is hard work. WWMW MD.D? (What would Marcus Welby, MD, do?)
Devil: Like Haley, I told you to just let it go. She has two boys, too. She understands. It’s just creative expression.
Angel: Well that creative expression goes by the name of vandalism, too.
Devil: Killjoy!
Angel: Just wait until his father gets home.

image from google image

Announcing our next Topic Day: Childcare

We're planning our next MiM Topic Day on Childcare for Wednesday, 9/16. If you're not familiar with our Topic Days, this is a day that we devote to one specific topic. Please join us and submit a post on anything related to Childcare: your childcare decisions and how you've felt about them; daycare; babysitters; childcare regrets; finding a nanny; before/after school programs; really, anything about the topic is fair game.

Submit guest posts to mothersinmedicine@gmail.com by Monday, 9/14 to be included and include a short bio for yourself (as anonymous as you want it to be).

See our past Topic Days for ideas.

Hope to see you on the 16th!

Thanksgiving

Forgive me for getting carried away here. I know it's the first day of September, but I stepped outside, and it was CRISP today. School buses were lumbering down the road, which I noticed more than usual since I have a kindergartener today for the first time. Regardless of when the autumnal equinox is, it's fall. I can feel it. My favorite season. And close to Thanksgiving, my favorite holiday.

In a half-hearted attempt to get our chaotic home in order before school started, I cleaned out our file cabinets this weekend. Well, actually just one of them. And just one drawer. But as JC points out, you've got to start somewhere. I picked an easy one, our "professional" drawer, with copies of diplomas, DEA forms, board certifications, licenses, transcripts, and hospital privileges forms, that usually doesn't require excessive discarding. At the back of this drawer was a folder I had almost forgotten about in the overwhelming busy-ness of my life as a doctor mom of three. It is labeled "Feedback" because that fits on the tab and is less embarrassing if discovered than "Affirmation" or "What you are doing does matter, Dr. Tempeh" or "Yes, your doctoring career has taken some hits because you have small kids, but take heart-- you have been good and will be again, and this is the folder to prove it". The folder includes glowing letters of recommendation (possibly intended for someone else) from when I was a young, energetic, childless resident applying for fellowship, over-the-top attending evaluations (clearly intended for someone else) from when I was a 36 week pregnant first-year fellow continuing to moonlight to save up for our first baby, and mostly a lot of thank you cards and letters from patients. I love this folder, and not only because it buoys my spirit when I wonder if I am losing my way, navigating these two lives that often run parallel and occasionally collide head-on. It is a little time capsule of my former doctor self that resides in our home. And it can bridge the gap when there is a dry spell of gratitude at home and at work.

As I sent my little guy off to full-day kindergarten today, I found myself wondering if I should have done these last 5 years differently in some way. I started working part-time 3 years ago. The extra time it has given me with my 3 kids is priceless beyond measure. But, at times I have wondered if it was worth it from a career perspective. After all, it wouldn't be that long until all of my kids were in school with full-time jobs of their own in some sense. Would I have sacrificed so much in my career by that point that I wouldn't be able to "get back," whatever that means?

The truth is that my career has changed for having kids, and it is probably kind of irreversible. Much like your body before and after children, you don't have to take the changes lying down, but you do need to come to terms with the fact that you won't ever get back to exactly the way you were before you had kids. And if you want to get back to something that closely approximates it, you are in for a long road and a lot of hard work.

But today, as I watched my little boy walk into his kindergarten classroom, then turn around to come back, kiss me on the cheek, and say, not "I love you" but "thank you, Mommy," I realized that I was in no rush to get back to my old life. I am happy right where I am. Fellow Doctor Moms, Happy Thanksgiving!