yet another posting on career vs. family

A few months ago I was having a not-so-great day on the Transplant service. The not-so-great aspect of this day had been brought about by the need to discharge a single patient after his allogeneic stem cell transplant. Having to discharge a patient after allo stem cell transplant is both the most mind-numbing and complicated role of the fellow on the BMT service as it can involve the need to coordinate home health, home blood draws, line care, monitoring of drug levels, home antibiotics, home TPN, outpatient medication, PT/OT equipment, transportation, clinic follow up, and a lot of patient teaching.  In fact, no discharge would be complete without an irate call from the discharge planner about some order I entered incorrectly.

While although important, this isn't very satisfying work and I was already a tad annoyed by some of the inevitable “complications” that had arose. I was trying to hide this annoyance and get through attending rounds quickly when my attending turned to me and mentioned that there was a grant proposal meeting regarding a clinical trial our institution was trying to get off the ground. It was this afternoon and I should definitely go.

My annoyance deepened.  Oh sure Dr. Attending. With about ten thousand little BS issues I have to resolve in the next two hours, I definitely want to go to your grant proposal meeting. Wonderful.

He mentioned the trial would involve the use of autogenetic stem cell transplant in patients with HIV-related recurrent lymphoma with the goal of curing the recurrent lymphoma and eradicating the HIV.

Now he had my attention.

Although I complain about the fellow’s role on the BMT service, I actually find transplant fascinating and have considered extending my fellowship for additional BMT training.  And while it might sound strange, I also find HIV fascinating and for a brief period considered ID just so that I could study and treat HIV (the fact that all the ID peeps I know get to do some wild traveling might have contributed to my interest).

A corner of medicine that involved both? Here, at our institution? I was definitely interested.

The meeting was between the clinical transplant staff and the basic science team. It started with the members of the lab explaining each step in the development of the vector carrying the gene for HIV resistance and how it would be introduced into the patient’s stem cells. I don’t want to embarrass myself by pretending I could follow all of the molecular biology, but followed enough to become very excited by this project that bore more resemblance to science fiction than any clinical experience I had ever had.  My attending then took over and explained what they proposed would happen to the patients who received the genetically modified stem cells.

I’ve worked on a lot of dead-end and/or boring research projects. In fact, I’ve never been part of a project that really piqued my curiosity, although some have been better than others. I had certainly never felt as excited by any project as I was sitting in that dark conference room.

I wanted in. I wouldn’t care what menial task it was, although I did start to envision what it would be like to write the first manuscript of a paper on curative HIV therapy.

My unborn son thumped me and reality set in. It is not a bad reality, but it is this – I almost certainly not staying at my current institution when I am done with training, and this project is still years away from inception. This is not because I don’t want to stay– and sitting in that room I really wanted to – but because we need to move closer to family when I am done here. I am actually very fortunate in that, my husband, who has followed me three times during my training, wants to move to the town in which I grew up and I have promised both him and my family that we will relocate as soon as I complete my fellowship.

I have also already decided against additional BMT fellowship training, which would almost certainly be required of any MD who wanted to be a part of this project. I have multiple reasons for this decision, including the need for a job with regular hours (please!), the need to start paying back my loans, the obvious financial needs of our expanding family, and again, the need to relocate. I like transplant, but I don’t feel as though it is something I absolutely have to do in order to feel intellectually and professionally satisfied. 

But I can’t pretend part of me doesn’t want to go after this. After all, I started med school when I was almost 22, I am now 31, so what is just a few more years of bad hours and worse pay for the chance (and it is really just a chance…) to be a part of something huge?  Maybe this isn’t the time – after I have almost a decade invested in my training- to start passing up opportunities.  

But that wistful, sometimes nagging, line of thinking hasn’t dominated my decision-making and, at least right now, I am very comfortable with the current plan as it is in place. 

This has become a much much longer post than I had intended and I worry I might have lost some of you along the way. This is unfortunate because part of my reason for posting it is to get feedback from those of you who have faced similar decisions. To be clear, I really don’t think I will regret the decision to move and forgo the very remote possibility of being part of this project, but it is the idea of slamming doors now, so early in my career, that is unsettling.

Thoughts?