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!

Bill

I wrote this entry about a week ago about a former resident colleague of mine named Bill. I hesitated to post it because I don't kid myself that the internet is completely anonymous and there's enough information here that Bill might be able to identify himself. But then I thought to myself: would that be so awful? I respect Bill, but I also wished I could tell him personally some of the things I wrote here, but I didn't have the courage. Sometimes it's hard to see things from the other person's perspective. For all I know, he's writing about ME in his "Men In Medicine" blog.

(And maybe next week, if I work up the nerve, I'll tell a story in which roles were reversed and I was the "evil" resident.)

So here it is:

I met Bill as a med student both rotating at the same hospital. He always struck me as a really upstanding, solid, reliable person. He was the kind of med student that any residency program would be lucky to get, not so much because he looked good on paper, but because he actually WAS good.

When Bill and I matched at the same residency, I learned that I was absolutely right in my initial assessment. Bill was a hard worker, reliable, and knowledgeable. He also had a staunch sense of what was fair. Therein arose the conflict.

I became pregnant during my first year of residency. Among other minor difficulties this caused, one that was a frequent annoyance for me was the rule that a physician had to hold the heads of certain patients getting flexion-extension spine films. On the spinal cord injury service, this problem came up maybe twice a month on my service.

The first attending I worked with immediately offered to go down with the patients and take the brunt of the radiation. Unfortunately, the second attending refused to do this. "I don't understand," she said to me. "Why can't you just wear lead?"

(I won't get into a discussion of the safety of radiation during pregnancy and how some radiology techs wear lead counters, etc etc. All I have to say is I think it was reasonable for me not to want to be in the way of X-ray beams while pregnant if at all avoidable.)

Anyway, I was forced to find another resident to help me out. I was actually the only female resident on service and most of my male colleagues would immediately agree to go down to radiology for me. The whole thing took maybe 15 minutes tops. There was one guy who would sometimes call me and ask if I needed him for any radiation-intensive activities.

Bill wasn't like that though. I remember there were two occasions when I asked him to do this favor for me. Once he outright refused and the other time, he replied, "What will you do for me?" He wasn't smiling or teasing. He meant it.

Bill had a strong sense of fairness, as I said. He was married, but had decided not to have children. He was the kind of resident who rarely called in sick. And I understand that he didn't want to feel like a sucker who was doing everyone else's work. However, I didn't keep a scorecard. Even when I was well into my pregnancy and my work for the day was done, I would stay late helping other residents. I remember a specific situation several weeks earlier with one of Bill's patients, when the orthotists needed one of his patients' heads held by a physician while they adjusted a brace within the room... I told them not to bother paging Bill and since I was on the ward, I would hold the patient.

So yes, it frustrated me when Bill pulled out the "eye for an eye" card with me, especially when he knew I was desperate. I think that in residency, you help the people who need to be helped. And if they don't help you back, then they help someone else who needs help, and then that person will help someone else, and so forth. I finally felt redeemed for my maternity leave (two years later) when I covered two services at once for a month and a half for another resident taking family leave. It was a lot of work, but it felt good to help out.

This wasn't my only run-in with Bill. When he became chief resident, he instituted a rule that if anyone was late to our weekly morning lecture, even once, they would get one extra call. There would be no excuses. Bill said to me, "I don't care if you're in labor, if you're in a car accident... if you're late, you'll get an extra call." Again, he wasn't joking.

I was furious about this. I had the best lecture attendance of anyone in my class, other than perhaps Bill. But I was also a mother and things could come up. What if my nanny was late? "What's the difference?" Bill said. "It's just one night of call." (Those of us who have done residency can roll our eyes at that statement.)

After arguing back and forth with Bill and stressing over it for days, I finally had to take the matter to the program director, who said that the rule was directed at people who were chronically late, and I wouldn't be penalized if I had an emergency come up.

I was right about Bill that he ended up being a great resident. In so many ways, he was exactly the kind of person any program director would want to fill their residency with. And I considered him a friend. Yet it's hard for me to praise him without feeling hurt by all the times when I wished he had shown a little more compassion.