Change of Plans in Haiti
When I started medical school, I thought I had my life all planned out. I would get through medical school and residency, then get married and have children sometime in my late thirties. I didn’t have time to concentrate on a relationship during school. I was too focused on acing the next pop anatomy quiz. Funny how life sometimes has other plans for you…
During the summer after my first year of medical school, I went to Haiti to do research on infectious diarrhea in HIV-positive patients. A summer turned into a fifteen-month stay and an experience that forever altered my life. However, it was not the trials of living in a third-world country, nor the tropical medicine I was learning which would change the course of my career. Instead, it was a blond man with a surfboard that I met in a hotel parking lot.
What started as a chance encounter turned into a whirlwind romance. During the next few months, we spent as much time together as possible. Since I was away from medical school, I had more time that year to develop a relationship than I ever would have had while in school. I spent twelve hours every weekend on a bus with chickens running around crapping on my feet, swerving at high speeds around craterous potholes to get to his village for visits. Given the political unrest in the country, there were even times we drove, quite literally, through burning barricades to be together. When we could, we escaped to deserted beaches or into the mountains. Indeed, it was only three months into our relationship when he proposed to me at the top of a waterfall high in the hills.
Stunned and exhilarated by love, of course I said “yes.” Then came the difficult logistics of reorganizing my life, career, and family planning around my new partner. My soon-to-be husband was six years older than I was, and he wanted to have children soon which had not been part of my original plan. First I needed to finish medical school, and then some unknown number of years of additional training.
I returned to the US without him and we lived apart for eight months before he arranged a transfer back to the States. I knew that as soon as he arrived, he would find our life together very different from what it had been during our carefree days in Haiti. I was just starting my clinical clerkships and the 80-hour work week was not yet in effect. I made him read The Intern Blues and other similar books to try to prepare him. Despite reading these texts religiously, he was still stunned by my workload.
After the wedding, we began to discuss potential specialty choices for me which would provide us with a good quality of life, and in particular allow us to be good parents when we did have children. I had originally been interested in pediatric oncology, but the years of training, office hours, and commitment to patients outside of office hours did not seem to mesh well with raising a family. When I did an emergency medicine rotation, I realized that not only did I enjoy the fast pace of the emergency room, but I also appreciated the ideas of shift work, minimal call, and working less than 40 hours a week at a good salary. I could complete a residency in just three years and be out in the workforce sooner. Also, once I was done with my training, I would have the option of working exclusively nights, which would allow me to be at home in the evenings to cook dinner and put my children to bed. I could sleep while they were at school and work in any academic commitments around their schedules.
During my intern year in emergency medicine, we tried to get pregnant. It did not take us long to realize that the chance of my even being home while I was ovulating was slim to none. Fortunately, a storm of biblical proportions hit the city that winter and solved our problem. Deemed “the Blizzard of the Century,” it took days for snow plows and the National Guard to dig us out. While many of my colleagues were stranded at the hospital, I was “trapped” at home with my husband. Nine months later, our first child was born.
One of Those Crazys
Some of us are just crazy enough to want to do even MORE training after residency. I was one of those “crazys.” So at the end of my second year of residency, I applied for a clinical fellowship which included an advanced degree. When I was accepted, I felt like everything I had ever dreamed of in a medical career was coming true for me. What I had not realized is that fellowship is even more grueling than residency. Don’t get me wrong—I had been warned. But others are not as tough as I am, I had decided.
I just could never have imagined what it would be like to get home at 7 pm with a migraine after 12 hours on my feet, to get paged by the hospital while breastfeeding my one-year-old daughter with my ever dwindling milk supply, and to run to my car to go back to the hospital urgently while breaking the seal on my daughter’s latch while handing her off to my husband. It was definitely traumatic—for me! She was fine.
What’s Your Smallest Cap and Gown?
My two-year faculty development fellowship included a public health degree. My schedule included time for coursework and my degree was to be paid for by my department.
I had my first child during the second year of fellowship, which worked out perfectly, more by accident than through meticulous planning. By taking classes during the summer between years 1 and 2, I was able to complete all of the course work for my degree in the first 18 months of fellowship, which left the spring of my second year to write my thesis. With an April due date, I had just the right amount of time and flexibility to finish all of my degree requirements before the baby was born. I brought my 2-month-old daughter with me to graduation.
A Highly Recommended Course
As a way to enhance both my personal and professional development, I took a 40-hour Certified Lactation Counselor (CLC) course. This educational experience is offered at multiple locations across the country at various times during the year.
I was the only physician in my course, which is apparently typical. The other attendees were nurses and peer counselors from the Women, Infant, and Children (WIC) Program. As the only doctor, it was illuminating to hear other groups of health professionals speak about “them,” meaning all doctors. It was not always glowing commentary.
I learned much more about breastfeeding that week than I was taught during medical school or than I learned as a new parent. For me, the CLC course was a wonderful synthesis of my personal and professional existences. It made me both a better mother and a better doctor for patients who are new mothers.
Learning Limits
I work part-time and have done so since completing my residency five years ago. What does “part-time” mean? The answer often depends on the day of the week. The practice of medicine is predicated on a full-time schedule that frequently extends well beyond the 40-hour work week. One of the skills I have worked hard to develop is the ability to recognize when my 50% job is beginning to look more like a 75% job. When that happens, I re-focus my responsibilities to reflect my priorities.
Learning to set limits in my professional life is less complicated than doing so in my personal life. For example, every afternoon at three o’clock my nine-year-old calls me at work. Sometimes these calls are quick: “Hi. I’m home. I had a great day.” Sometimes they are not, especially if the homework assignment is too tough or a social interaction with a friend went awry that day. I am not sure I will ever master the skill of gracefully ending a phone call with my beloved child when she is upset, especially when I am in the middle of a meeting.
On Call for Life
One of my greatest joys as a physician is to deliver babies. It is why I went to medical school. There is nothing more amazing than participating in the start of a new life. A birth is often a family celebration, in contrast to the challenges and suffering that we share with our patients when they are sick.
Obstetrics is one of the most rewarding parts of my job–and, since I had my children, one of the most daunting as well. I can take call from home, but I have to be able to leave my house at a minute’s notice and drive directly to the hospital. So when I am on call, I cannot be the sole childcare provider for my kids. Often my husband is home, so he is there if I have to go to the hospital. Sometimes my parents who live a few miles away are on call with me. They keep their overnight bags packed. If I get called in, then they get called over. Sometimes I ask a work colleague to cover for a few hours when neither my husband nor parents are available. As a last resort, I hire a babysitter, in which case I am literally paying to take call. I have spent several enjoyable but expensive evenings over the years at home with my pager, my kids, and my babysitter, waiting for a patient to go into labor.
Fight for Your Rights
Why is talking about money with your employer so hard? Liken the situation to purchasing a service for your home, such as lawn care. The usual manner in which this is done is that one acquires a number of estimates, negotiates with the prospective employee, and eventually picks the one that seems most reliable, is relatively inexpensive in comparison to the others, and has a good reputation for getting the work done well. Negotiating for the proper salary should not be any different.
My mother worked as a saleswoman for an oil company in the early ’80’s. I clearly remember the day she accidentally came across her male colleague’s paycheck stub. He was making almost twice as much as she was for the same work, with the same level of experience. She walked out of her job that day and never returned.
That was her response—to walk out. It did not occur to her (or did not seem possible for her), a very strong feminist I might add, to go into her employer’s office and fight for what was rightfully hers: equal pay for equal work! But even now, in 2008, as women are increasingly visible in the workplace, we get paid less then men. Doctors are no exception.
Tough Love
While five months pregnant with my second child, I was admiring the CV of another older female faculty member in the department’s printer. It was eleven pages long! I said, “Wow, now there is a career goal. I want to have an eleven-page CV!” One of the (female) secretaries also waiting at the printer said to me, “Well that’s not going to happen if you keep having babies.”
Mentors and Models
I work full-time as an academic physician. I spend 20% of my time seeing patients, 40% of my time teaching in a variety of settings, and 40% of my time on academic work such as writing articles, grants, and books. I also have overnight and weekend call responsibilities. I travel about once a month for work. I have three children and another on the way.
I love both my job and my life. Although I work full-time (and then some!), the academic aspects of my job provide me with significant scheduling flexibility with respect to my family. For example, if I am teaching in the evening, I may leave work early on a different day. As another example, I can interrupt a writing project to attend my daughter’s school play for an hour on a weekday morning, which is not something I could easily do as a full-time clinician.
The majority of my mentors and colleagues are men and the majority of the medical students and residents with whom I work are women. The few senior women faculty that I know are from a different generation of mothers in medicine. More than one has told me that she “succeeded” in academic medicine by never acknowledging the existence of her own children at work. Now I know women in academic medicine who either decide not to have children or are miserable because they never see the ones they have. I also know women who do not even pursue or drop out of academia because of their children.
Because I see very few academic physician-mothers role modeling balance, it is hard for me to envision what it looks like except through my own trial and error. My peer mentors are my best role models. We are keenly aware of our responsibility to the next generation of women in medicine.
Dr. Teacher
A few years ago, I went with my five-year-old daughter to get her first library card. It was a really big deal for her to complete the application herself including the signature. Even though it took a while, I was very patient, helping her through it one letter at a time. At one point, the librarian commented, “You must be a teacher.” I initially responded, “No” since I think of myself as a doctor, but then I realized that well, actually, I am a teacher. I am an academic physician in a teacher-scholar track. I teach medical students and residents and fellows all the time.
Teamwork
I currently participate in four different academic teams. One is my administrative group that works on medical student education: two physicians including me, an administrator, and a secretary. We run a course, give presentations at national conferences, and perform medical education research. A second team is a group of faculty in my department who share an interest (clinical, educational, and research) in maternal-child health. Third, I do research with a group that includes a PhD public health researcher/nutritionist, a programmer, a statistician, and a medical student. We write original research papers using secondary data analyses of national data sets. Finally, I work with a group of physicians, lactation consultants, Department of Health managers, and legislative liaisons on maternal-child health advocacy at the state level. Each of my teams has people on it with different training and expertise than my own. As a team, we accomplish far more than any of us could as individuals.
“Where Did You Get the Babies?”
I once visited a high school with a medical student to teach a session on infant nutrition. We were there to teach students about breastfeeding and infant formula including formula company marketing strategies. The medical student and I both brought our own infants with us. When we told the students why we were there, they looked initially interested and then confused. Then one of them asked us, “So where did you get the babies?” It was truly a surprise to these young students that we could be both teaching and parenting at the same time.
Now it is several years later. I am a faculty member in one specialty and my former student is finishing her residency training and contemplating a career in academic medicine. The infants we took to that presentation are in elementary school and we each have more children. Since we are in totally different specialties, I am no longer a clinical mentor for her as I was when she was a medical student. Instead I now serve as her academic mentor and her mother-in-medicine mentor.
Congratulating Clerk
I was out of town at a conference on the day that my university’s Promotion and Tenure Committee met to consider my promotion from Assistant to Associate Professor. My chair had told me the exact date of the meeting but had also warned me that it might be a day or two before there was a final decision. Prior to my departure, I left him the contact information of the hotel where I would be staying. When I arrived at the conference hotel with two of my children, the desk clerk was explaining the usual check in stuff to us: room number, breakfast hours, the pool location, etc. I was only half-listening to her because I was also trying to keep track of my one- and my seven-year-old who were running around the lobby after a long day of travel.
At the end of the desk clerk’s monologue, she looked down at the papers in front of her and then back up at me and added, “Oh, and your chair sends his congratulations on your promotion.” I did such a double take. “Could you repeat that last part, please? What you said right after how to find the pool.” She did and it was confirmed: I had been promoted! Yeah. So there I was in the lobby of a hotel far from home jumping up and down with my kids.
My girls and I went out to dinner that night to celebrate. Since I was clearly elated, my seven-year-old asked me a bunch of questions about promotion. At the end of our conversation she said, “Mama, I don’t really understand any of that. But I’m very happy for you.”
Hand-off Before Takeoff
Once, I was at a conference with one of my administrative colleagues and my four-month-old son. We were on the same flight home but she had boarded the plane earlier than we did. When we got to our seat in the row ahead of my colleague, my son was wailing. So I turned to her and said, “Hey lady, could you hold this baby while I get my seatbelt on?” and promptly handed him off. Our fellow passengers were horrified that I had apparently just given my baby to a complete stranger. We laughed for months.
Baby Flip
When traveling for work with my kids, I bring my laptop on the airplane loaded with movies to entertain them during the flight. I make sure my presentation and key work documents are saved somewhere else as well, not just on the desktop where they are very vulnerable to deletion. My kids can actually rename hard drives.
I don’t hang my laptop computer over the back of the stroller anymore. Not since the morning in a connecting airport when my son was sleeping in the back seat of an in-line double stroller. When his older sister got out of the front seat, the entire stroller flipped over backwards with him in it. Incredibly, he slept right through it.
The Lady at the Ducks
I was recently at a national medical education conference. I was able to bring my infant daughter with me thanks to the kind assistance of others from my institution who covered various hours of required meetings and presentations in terms of childcare. This particular conference hotel had an event where there were ducks in the lobby that were grandly escorted on a red carpet to the elevator at 5:00 pm every day.
On the opening day of the conference, in the presence of 200 medical educators, including many of my senior faculty colleagues from around the country, I was with my daughter to witness this daily event. We were kindly seated by other attendees in the front row with more than 100 people directly behind us. The “duck master” was droning on and on, at which point my daughter, who was quite tired from traveling all day, pitched a complete and total fit. Unfortunately, we were literally unable to leave the event. In front of me was the red carpet which I was told at the beginning not to step on under any circumstances. Behind me there was a large crowd with too many people packed in for us to get past. We were trapped.
As if this were not bad enough, then a local tourist leaned over me in front of everyone and started screaming that I personally was ruining this moment for him and the other people who had come from all around the world to witness this event. Shocked and distraught that now two people were screaming, my only recourse was to literally crawl behind two people in the front row and sit on the floor in the crowd, nursing my infant to solace in a forest of tourists. A few minutes later, the event broke up and everyone went on their way.
The next day, I went with my medical students to give a presentation, and when I introduced myself to the moderator, she asked me why I looked so familiar. Then she got this keen look in her eye and said to me, “Oh, I know, you were the lady at the ducks!” I would not recommend this approach as the ideal way to gain a national reputation and score some letters for promotion, but it will get you recognized!
Unsurprising Assumption
I co-teach in a year-long course for first-year medical students. My small group co-leader is a social worker. As part of the course, medical students interview standardized patients to learn basic medical interviewing techniques. One day, at the end of her interview, one of the standardized patients decided to offer unsolicited medical advice to the group of eight first-year medical students, me, and my co-teacher. The patient wanted to confirm the medical information which she had just stated so she turned to my co-teacher, who is an older, white man, and asked him if what she had said was true or not. He said “I don’t know.” And she said, “Well, why not?” And he said, “Because I’m not a physician.”
At that, the patient looked very confused and then started scanning the room which included me, a young woman, to find a physician. Her assumption that only the older white man could be a physician played out in front of the group quite clearly. The impressionable medical students, five of eight of whom were women, were shocked by this experience. I, however, was not simply because it has happened to me so many times before.
Alternate Reality
As a physician-mother, what would an ideal job look like? Here is my version of doctor-mother utopia. First, every day I will have breakfast with my family. Then I will take all of my children to school with a little extra time to speak with each teacher if needed. Their schools will all be very near where I work so I can easily participate in parenting activities during the day if I want. If my kids are sick, they can come to work with me since there will be emergency childcare for sick children available at work as a free employee benefit. Right next to the on-site daycare and the employee lactation room. And the gym (or am I getting greedy?).
Even though I cherish motherhood, I am not really a part-time kind of person. So I will work full-time (but 40 not 80 hours a week) and get paid full-time. My work days will start at 9 am. I will eat lunch sitting down on a regular basis. I will be done by 4:30 pm so that I have enough time to pick up the kids and have an early dinner with my family before anyone gets too grumpy. Once or twice a month, I will stay late at work to get caught up. Except for my occasional work night, I will NEVER have work obligations that do not involve my children between 4:30 pm when they get home and 8 pm when they go to sleep. Work events where my kids are welcome would be ok for evenings and weekends.
During the day, I will have outstanding administrative help including instant access to a clinical nurse, a research assistant, a grant writer, a mid-level educator, a secretary, and tech support. My dream team can accomplish every part of my job that you do not need to be a doctor to do. That way I can spend my time providing clinical care, teaching, and writing in equal parts.
I will get pregnant exactly when I want to and not when I don’t want to. My boss will be thrilled when I tell her the good news. When I am pregnant, I will no longer take overnight call after 28 weeks gestation and my paid maternity leave will start at 36 weeks and continue for six months post-partum. When I am lactating, I will have regular time in a private, sanitary place to pump with an electric breast pump provided by my employer.
My husband will also have a fulfilling career. We will share the family responsibilities equally. We will have enough financial security to pay back all of our student loans quickly, have safe but not fancy cars, and take one amazing family trip each year. We will be able to outsource laundry and lawn care so that we have more time to spend with each other and our family. We will exercise regularly and sleep well each night.
I will travel to interesting places for work a few times a year. Most of my conferences will be scheduled for when my kids are not in school so that they can come too. My work will pay for one additional person to travel with me so I will have childcare on site for my children. We will arrive a day early and stay a day later each trip.
Certainly, for all the incredible personal and professional successes that I have experienced, this is not what it was actually like for me. Granted that my personal utopia is not everyone’s ideal, by any means. Through both smart choices and good luck, some physician-mothers are experiencing parts of their own dream scenarios. In the future, I hope that more and more physician-mothers can work exactly when and how they want on their own terms.
Mama, M.D. 