MiM Mail: Advice for an ex-husband of a MiM-to-be

Hello!

Being a father not interested in medical school makes me a somewhat non-traditional reader I imagine.

I am ultimately writing for advice. I read a number of great posts on your blog, but I am coming at this from a different direction and was hoping one of you would be able to point me in the right the right way.

My ex-wife is a brilliant woman in her Junior year of her undergrad and planning to start applying for medical schools. We have a good co-parenting arrangement and try to do our best by our three boys (4, 5 and 7). I am no longer in the medical field but do have 8 years experience as a critical care paramedic so I can appreciate both how talanted she is and how hard her road is going to be. She is going to apply locally but is also looking at the Virginia area due to family there. I am willing to consider relocation if I can find appropriate work (I work in IT in a rather specialized area).

My question is, how can I best approach the subject of custody? I don't want to take the kids away from her by any means (she is a fantastic mom!), but I am concerned that raising three young school age boys while attending medical school will be overwhelming. She can accomplish anything she sets her mind to, but even she can't accomplish *everything*.

My initial thought is to offer/ask to take the custodial role, freeing her up to apply herself 100% at school while still affording the boys a stable home life and predictability in routine. I don't know for sure how she would receive this, but suspect she would at least be willing to consider it. Then again, as a divorcee my ability to mis-read her intentions is a matter of public record. : )

There has to be a mutually beneficial way to handle this situation that benefits all of us, and I am looking for advice on where I could look for information. I have looked at some of the schools websites for information on family services offered by medical schools but it's hard to find in a lot of cases.

If you have a moment, would you be able/willing to point me in the right direction, or even offer some insight from your own experiences?

Many thanks for your time!

MiM Mail: Making residency safer for pregnant residents

Mothers in Medicine! I am seeking your advice/expertise on the difficult subject of how to treat pregnant residents. A little background: I am a chief resident at a busy anesthesia program that takes frequent and draining 24 hour calls in the OR. Those calls are such that, most of the time, the call room is a distant fantasy. I am also a mom to an active preschooler and pregnant with #2. All was going well until after a particularly exhausting 24 hour call, when I started having frequent, regular contractions at 20 weeks. I had to take several days off work and (thankfully!) things calmed down. I'm now trying to ease myself back into the OR call rotation.

My question for all of you who have been through a resident with tough, frequent 24 hour calls or night shifts... how did your program handle pregnant residents? I've heard from friends at other programs about policies that were put in place to limit calls because so many pregnant residents were going into preterm labor. Other programs limited night shifts for the same reason. Obviously, these changes put strain on non-pregnant residents. Was there widespread resentment to enacting such restrictions?

Amazingly, I'm the first resident to be pregnant at our program in over a decade, but I know there are many women behind me hoping to do the same. I'm hoping to find some common sense changes that can be made to keep pregnant residents working, but in a safe way for mom and baby.

Thanks in advance!

From premed to med

So in the last two months I managed to do most of the things on my list. We moved nearly all our stuff down and unpacked while I was 37 weeks along. SK's birthday bash went smoothly. Our house is rented. Baby #2, SE arrived and is happy and healthy. We waited until she was two weeks old, packed up our remaining items in a U-haul and made the ten hour drive to our new home. (It's really only supposed to take six hours, but every 30 miles someone either needed to be fed or had to pee.) And now we are here, adjusting to life with a new family member, in a new city, with new schools and jobs. Everyone I've told about our moving experience has thought we're completely nuts, which we are, but we had a plan, stuck to it as much as we could and anything else that came up, we decided to just roll with it. In fact, these last four words have really become my motto as of late, so much so that I can basically take a picture of our crazy lives at any moment and have #justrollwithit be a fitting caption.

My first week of school was packed with such moments. No one to drop off or pick up SK from school on Monday? Just stay home with grandma and do some crafts, eat lots of treats and watch too much TV (#justrollwithit). Get to school and realize I brought my pump but forgot all my pump parts at home? Use the lactation room's backup pump and try to ignore the idea that others have used the same pump (#justrollwithit). Motion-sensor lights turn off in lactation room while pumping, leaving me fumbling around in the dark? Dance like a mad woman in the chair, still attached to my pump until the lights turn on (#justrollwithit....ok there might have been some expletives here and there).

I'm starting to realize that my med school experience is going to be a little bit different than what I had envisioned. I missed out on most of the socializing opportunities my first week because I had to run down to the first floor lactation room to pump while everyone else ate lunch. In fact, it is lunch time right now as I write this and I'm being serenaded by the gentle pff pff pff of my lovely pump. When our social calendar first came out I foolishly rsvp'd to several different events which I'm now realizing was a tad bit ambitious. I guess having a preschooler made me forget what newborn schedules are like; I forgot about the eating every 3 hours thing and the getting up multiple times at night routine. I am feeling a little bit left out, but I know the social aspect of med school will come with time, especially when the little one is a bit older. My biggest struggle right now is trying to figure out when I'm going to find time to study and I'm hoping with some trial and error I'll figure it out. Yesterday an assignment took me 5 hours...maybe 1 hour of actual work in total, 1 hour playing DJ for SK so she could perform dance routines in the living room, 30 minutes of reading Fancy Nancy books, 30 minutes of redirection, timeouts and talks, 1 hour of snuggles and cuddles, 45 minutes of breastfeeding and 15 minutes of accidental sleeping. By the time everyone else is actually in bed and I can study without distraction, I'm about to face-plant into my laptop.

I am loving what I'm learning though and I'm thankful to be in a great program. It's the logistical part that's scaring me right now. I can feel the dreaded "what have I gotten myself into" question creeping into my mind sometimes, but I'm pushing it aside for now. I'm rolling along and I'll be rolling with it for the next 4 years and probably thereafter.

MiM Mail: Lost

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

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

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

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

Every little bit

2 weeks into attendingdom, I am starting to realize how life has changed fundamentally. Gone are the days of working 75 hours a week. Gone are the days of calculating TPN and anion gap. Gone are the days of being questioned about details that you struggle to remember and know you’ll never need again outside of residency. I now work 4 days a week and can pick up a weekend day if I want to. We haven’t had an office emergency that I have managed yet, but I’ve got emergent management for the 15 or so minutes until EMS arrives down. I’ve got that!

In spite of my nice schedule and awesome colleagues, I realize that it will take a while to let go of my resident mindset. During residency, a resident-mommy-friend and I would chat and comment about how guilty we felt missing out on things. Not being able to care for a sick child. Not being able to make it to bedtime. Missing out on weekend fun. And I realize now that although I won’t be able to always take off to care for my sick child, I have more flexibility to. I now can make it to bedtime every day of the week. And other than my one Saturday a month, I’ll be around for the weekend fun.

Last week on my off day (every Friday), I attended Zo’s first summer camp performance and the joy on his face when he saw me cheering in the front row was priceless. It’s taking my breath away now to remember it. I took him home early, we played at the playground and then went home for family dinner time. I am at a coffee shop now writing this post before restarting a timed section of the 2014 Prep pediatric board questions. This week, I got to attend his second performance and it was just as cute. This week I was strong enough to let him stay for a few more hours while I study (last week I just couldn’t - since in the old days I very rarely could pick him up early).

I want to be able to enjoy every little bit. I want to be a present parent. I want to be a present provider. And I am (for the most part, I was kind of late for his performance today, but I just had to do 5 more questions and get that samosa from the local shop)! After so many years of waiting to “get there”, it’s here and it’s mine and I’m committed. Next time they ask who wants to work overtime I think I’ll pass and stay at home to snuggle with my family. Here’s to enjoying the little bits, the fundamental shifts, and this new phase in life. Question 151 here I come.

MiM Mail: Studying in residency

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

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

Thanks so much!

MiM Mail: Spacing of siblings

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

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

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

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

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

-K

Attending Status: let's go!

I woke up to the sounds of the birds chirping and then “Mommy!” as my almost 4-year old tried to start his day at 6:45am. Quick detour for a potty-break and then promptly back in his bed because, “It’s still too early. Time for sleep.”

As I sit at our desks, I double and triple check that my Epocrates app is up to date so that I can quickly calculate drug doses. Today is my first official day as an Attending. I am returning to my dream health care system to work in the pediatric clinic I did my third year community pediatrics rotations in. The Attendings and many of the front desk staff remember me back when I was a medical student and they, like me, are super happy that I have returned.

We had an all-day orientation yesterday that was truly inspirational - yes, I’ve drunk the Koolaid as they say and am already one of those super happy people to work where I work. Providing care to children in our nation’s capital is truly an honor and one that I do not take lightly.

During times like this I refer back to my favorite book The Alchemist (Paulo Coelho). I was tested immensely in these last few years, but every second of the journey brought me closer to the realization of my dream. Every struggle. Every triumph. And I’m here. In this moment. Feeling the immensity of years of pre-medical studies, MCAT struggles, public health school, medical school, biochemistry challenges, clinical year excellence, pregnancy during USMLE Step 2, birth, and being a mother in medicine.

I am totally ready for this aspect of my journey. I vow to do great things. So let’s go. Let’s get it. Pediatric Attending status 2015! (happy dance, happy dance, happy-praise dance!)

MiM Mail: Medical school timing

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

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

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

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

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

MIM Intro: Doctor Professor Mom

Hello, I am Doctor Professor Mom.  No, that’s not my real name but it’s a name that makes me really proud.  My oldest son coined it a few months ago when he learned that I am not only a doctor but I am also a professor and I am also a mom.  He seemed genuinely proud when he coined the name and, of course, I was equally proud both at his creativity and at some of my accomplishments.

Even as a Doctor Professor Mom, it’s hard to feel accomplished.  Maybe it’s something about academic medicine where I feel pulled in a million different directions. I teach; I do research; I see patients – it’s easy to feel like a jack of all trades and master of none.  Add on a busy family life and mastery is not in my cards.  But academic medicine has given me incredible flexibility, variety, and satisfaction.  Plus, I get to proudly say I am a doctor and a professor.

Of course my proudest accomplishment is not that I am a doctor or a professor but that I am a mom to three boisterous, energetic, and absolutely wonderful sons.  They are ten, eight, and six (gasp - how did they get so old).  After ten years of motherhood I have a lot to reflect on in managing a household with two equally ambitious working parents and ever changing challenges of parenting. 

I became interested in writing about my experience as a doctor and mother after my first son was born.  I spent 18 months crying every day when I went to work and decided (with the incredible support of my husband) to leave my job and stay home.  Then I struggled trying to find my identity as a stay-at-home mom (I wrote about this experience in an essay called Dr. Mom).  I returned to work and decided to focus on research and a career in academic medicine.  For me, it was an excellent choice.  That being said, the struggles of being a working mom, finding meaning and satisfaction in your work, and all the other challenges of life never go away even when you feel like you’ve found the perfect job.

When I wrote Dr. Mom in 2007, so many women contacted me and thanked me for sharing my story.  I promised myself I would write more, but, not surprisingly, life got busy.  I’m thrilled to have a place to write, to be a part of a community of women in medicine and hope that something I write will resonate with someone else. 

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.

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

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

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?

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

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.

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.”

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

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

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.