The title basically says it all: I just graduated from med school in June and am now a full-time SAHM with an MD after my name and a 6-figure debt to show for it. From reading some of the other posts on this board, it appears that it isn't all that uncommon for women physicians to leave practice to stay home, but I think I'm the only one here who decided to bail before even starting residency. I actually matched into my #1 choice of residency, but basically reneged on that agreement after moving here and fortunately the program was very understanding. I feel really bad for the program, but I'm sure they won't have any trouble filling my spot.
One sad fact of reality remains: My loan payments are $900 per month and my husband doesn't earn nearly enough to make that payment while supporting a family of 4.
So why did I do this? How did I get in this position? And, most importantly, what am I going to do with myself in the long-term?

Before I had kids, I knew there was nothing in the world that could make me as happy as being a doctor. I know because I tried everything else. I fought the desire to be a doctor over and over again. I told myself the hours were too long, the training too expensive, the sacrifices too great, the work environment too threatening. I listened to the dire warnings of miserable med students and miserable physicians.
But everytime I went back to volunteer at a local clinic for the uninsured, I knew they were wrong. My heart went out to these patients who all worked full-time jobs just to pay the bills, but didn't have health insurance. I saw a 54-year-old woman with Type II DM who couldn't afford her meds and was walking around with a HgA1C of 11.5. I met a 58 year old man who had waited three months for an appointment for shortness of breath-we slapped a pulse ox on him and he was satting in the 70's at rest. Despite his severe (undiagnosed) COPD, this guy had been dragging himself to his blue collar job every day, because he didn't get paid for sick days. I could go on and on, but you get the idea. I knew this clinic was where I needed to be. I knew they needed me to become a physician and come take care of these patients.
I can honestly state that I didn't give a flying hoot about money. I figured I would make enough to repay my loans and since I've never had much money in my life, I wouldn't miss it anyway.
I grew up in a working-class family myself. My dad was a blue-collar worker who got laid off from his job when I was in 6th grade, which is when we went on welfare, food stamps, and Medicaid. I worked at babysitting jobs until I was old enough to get a real job and then I worked mostly in restaurants. I served customers, prepared food, mopped floors, and cleaned bathrooms to pay my way through community college.
One of my fondest memories was one day when I was working the cash register at the local sub shoppe. In walk two gentlemen who are obviously professors- it's quite apparent from their demeanor. One guy is wearing a T-shirt with this equation on it:
They come up to my register, order their subs, and continue chatting with one another, mostly oblivious to me. You should have seen the guy's face when I asked him why in the world he was wearing a T-shirt with the Schroedinger equation of quantum mechanics on it. Priceless! I loved it- he obviously though I was some idiot blue-collar bimbo and he about fell to the floor when I said that.
OK, I have digressed. Let's suffice it to say that I worked my way through community college, then transferred to a state university and applied to med school. Since I had no source of income other than my measly restaurant jobs, I could only afford to apply to one school. I applied Early Decision to the closest school, was initially waitlisted, then ultimately rejected.

When I finally got rejected, a week after classes began, I was in shock. I guess it was naive of me to assume the school would ultimately accept me, but it never really occurred to me to come up with an alternative plan. So I wallowed around in depression and self-pity for a few months after that. Then I met yet another miserable bunch of third-year med students. One guy in particular exhorted me to find something else, anything else, to avoid medicine at all costs. When I asked him why he didn't just quit, he told me he had $25,000 in loans and a wife and two kids to support, so he was trapped.
I also realized that, other than the doctors I worked with at the clinic, I really didn't like doctors. They seemed so pompous, so high-and-mighty, so holier-than-thou. So I resolved to take the med student's advice and find something else. I went to graduate school, got a teaching assistantship, earned a Master's degree. Then my husband got a dream job that took us all over the country. He was a seasonal park ranger and actually got paid to take people hiking, wow! It was actually a ridiculously low salary- he started at $7 an hour and eventually worked his way up to $11 an hour with no benefits. But who cares? Who needs benefits when you're healthy, 20-something and get to live in the most beautiful places in America and go hiking every day of your life? I worked odd jobs- bookstores, gift shops- and followed him around the western parks for several years. After 5 years of this, he decided he had had enough and needed to settle down and get a decent job. We both returned to graduate school and he eventually got a decent-paying real job.
When I got back, the clinic was still there. Only it was even busier than before. I found myself wondering how I could ever have forgotten the medical dream. Truth is, I never really forgot it- I had just repressed it. My rejection from medical school had been so traumatic that I just couldn't deal with it. Like the proverbial fox and the grapes, I had told myself I didn't want that silly old med school anyway. But when I returned to my clinic after all those years, I knew I had been wrong.
So I retook the MCAT, did well, took some updated science classes, and reapplied. This time my husband was working, so I was able to afford the applications. I still only applied to 4 schools because I needed to stay close for my husband's job. I got one interview, at the same school I had been waitlisted at before. This time, I was rejected outright, no wait list.
Instead of getting discouraged, that second rejection made me more determined than ever to be a doctor. I started making tentative plans to study abroad if necessary and mounted a full-scale plan for reapplication. My husband said he'd move to the ends of the earth if that's what it took for me to go to med school. The third time, I applied to 20 schools, got 4 interviews, 3 acceptances, and 1 waitlist. I even got into a top-20 school, but turned them down for my state school, which I chose mainly for financial and geographic reasons, even though they had rejected me twice before.
The day my acceptance letter came was the happiest day of my life. Best of all, my husband was even more excited than me, if that was possible. It felt so wonderful to have him 100% behind me. I knew it wasn't going to be an easy road, but I knew I could do anything with his support.

During the six months between getting my acceptance letter and starting med school, strange feelings were stirring within me. Most women my age were having babies and I knew I wanted to have children too. I realized that med school and residency were going to take up at least the next 7 years of my life and that I would be nearly 40 before I was done. Around this time, I discovered MomMD and read some success stories of women who had had babies during med school. My husband was skeptical about my ability to handle it all, but he agreed that it would be tough to wait until after residency. He also agreed to quit his job and stay home for at least a year once the baby was born. We were both very good at saving money- even on his modest salary (in the 30's) we had been able to save enough to pay cash for a new car. And I had the first summer after medical school off, so that would give me three months to stay home with the baby. And 2nd year was still preclinical, so it wouldn't be quite as stressful as clinical rotations. By the time 3rd year started, the baby would be a toddler and easier to leave. It made sense, at least to my warped mind. So we decided to take the plunge.
I sat at my med school orientation charting out "o" (ovulation) and "m" (menstruation) dates for the next several months. Fortunately, it didn't take that long. I got pregnant two weeks into my first year of medical school.
I didn't believe it. I repeated the test. Then I repeated it again. Then I repeated it the next day, with a different brand. Then I went to Student Health and took another urine test there. Then I went to the local women's clinic and requested a serum HCG because it just didn't seem real. It was real. I was on Cloud Nine.

Once the initial elation wore off, nausea set in. I was sick all day and all night for 6 months. Somehow, I managed to pass all my classes and even honor a few. The only thing that helped my nausea was eating all the time, so I did. I gained a huge amount of weight- 55 pounds!
The baby was due 2 weeks before final exams, which posed a potential problem, but I met with the administration and they agreed to work with me.
The worst part was taking genetics and embryology during my 1st trimester. I developed anxiety so severe I was barely able to function. Worse, my AFP test came back slightly abnormal, but not abnormal enough to warrant an amnio since I was under 35. I anxiously waited out the rest of my pregnancy, praying fervently the baby would be ok.

He certainly seemed to be ok. He was a beautiful, robust 8-pounder who arrived promptly on his due date. He didn't have Down's. He didn't have a neural tube defect or Trisomy 18 or Trisomy 13 or any of the other horrible conditions we had studied in class. Thank God.
We brought him home and the crying started. He wouldn't sleep in his bassinet. He wouldn't sleep in his crib. He would only sleep in his infant swing and only if you kept it moving. So I would sit up at night and watch him in his swing while trying to study. My husband would take over for a a couple of hours around 4 AM prior to going to work so that I could sleep. Somehow, I managed to pass my 1st year exams, then had the summer off. After about 3 months, he finally started sleeping in his crib, but only for an hour or two at a time. He demanded to nurse every 2 hours all day and all night long. We took him to the pediatricians, who diagnosed reflux, but basically told us we needed to let him cry it out. We tried it one night, but just couldn't do it to our poor little baby. This went on for over a year.
Meanwhile, I had started 2nd year and determined that I could get by mostly by studying at home. So I skipped class, got the notes from friends, and stayed home except for the mandatory clinical and physical diagnosis classes. My husband took family leave when my schedule demanded it and we managed to make it through all of 2nd year without using daycare and with no family help. We planned for the baby to go to daycare during 3rd year so my husband could keep his job (his job had an on-site daycare). I actually honored all my classes that year and did really well on Step 1 (don't ask- I have no clue how!)
Despite the endless sleepless nights, things were looking good. Once we got over the hurdle of 3rd year, 4th year would be a cinch. Maybe we could have another baby then.
Our son grew more and more strikingly beautiful every day. He had a head full of curly hair, the bluest eyes you've ever seen, the most perfectly chiseled face you could ever imagine. Grown men would stop us on the street to stare at his beautiful face.
The strange thing was, he never stared back at them. In fact, he would act as if the people weren't even there. He would always look past them at the nearest bike or car or train.
My eyes are filling with tears as I get to this part, so I will have to pause for now.

OK, I've pulled myself together now. The memories of that time period are still so fraught with emotion. To make a long story short, my 1-year-old son didn't look at people's faces, didn't wave bye-bye, didn't play "peek a boo", didn't like to cuddle, didn't say "mama" or "dada". He was obsessed with spinning wheels. He was an extremely picky eater, eating only pureed baby foods. He was terrified of certain noises- animal noises, vacuum cleaners, sirens. Simply reading the sentence "The sheep says baaaaa" out of a book was enough to cause him to scream uncontrollably. He had missed several developmental milestones, but his pediatricians had repeatedly told us not to worry. They said I was just being an overly paranoid medical mom and given my history of excessive anxiety during my pregnancy, I was relieved and agreed.
It was my husband who first mentioned the "A" word. At 10 months, our son was so obsessed with spinning wheels, it seemed like that was all he ever did. When we went to his grandparents', he completely ignored them and instead sought out every wheel in the house to spin. My husband, thinking that perhaps wheel spinning was a sign of genius, did a google search and found several parents' stories about autism.
Even I thought that was absurd. "That's impossible!" I told my husband. "We are the most nurturing, loving parents any baby could ever have. Our child couldn't possibly be autistic." Besides, our child did make eye contact with us, he did point, and he loved to read books- he would bring us over 50 books a day to read to him.
But the older he got, the more apparent it became that he was very different from other kids. We took him back to a different pediatrician and were told not to worry. She said he probably wasn't talking because we just weren't talking to him enough - even though we TOLD her that one of us interacts with him all day long and that we read 50 or more books to him daily. We took him to a pediatric neurologist and were told not to worry. I found an internet discussion board on autism and the parents there told me to ignore the pediatricians and go with our gut, so we did. We called our state's early intervention system. They got him evaluated and found significant speech, social, and adaptive delays, so he started getting speech and occupational therapy at 14 months. With therapy, he did finally start gaining words. Two months later, we saw the child psychologist, who diagnosed our beautiful, perfect child with autism.

Words can't even begin to express how I felt when my son was diagnosed with autism. It really wasn't a big surprise, since I had known for some time that it was inevitable, but hearing it from a professional just seemed to import a terrifying finality to it.
I got angry. "WHY ME?" I thought. "WHY MY CHILD?" I felt guilty. What did I do to make my son this way? Was it the formaldehyde in anatomy lab? The mercury in the dental fillings I had removed at the dentist's office? The organophosphate pesticide residues that were in the lanolin ointment I unwittingly used for sore nipples while breastfeeding? Was it the mercury in all those tuna sandwiches I ate while pregnant? Maybe it was the thimerosal in the flu shot I got during my 2nd trimester. To this day, these questions haunt me. Science doesn't have the answers and I will almost certainly go to my grave not knowing the answers.
Meanwhile, my 3rd year of medical school had started and it was miserable. I was on my OB rotation, which was easily the most malignant rotation of my entire med school career. I was never late, never missed a day, never complained, even though I had the toughest call schedule of any of the students. But I got on one resident's bad side through no fault of my own and that haunted me the entire rotation and cost me my grade.
I thought about quitting and staying home with my son, but just couldn't deal with it. My guilt prevented me from accepting my son the way he was. I knew this wasn't good for him. My husband, on the other hand, said he was the greatest kid in the world, autism or no autism. We finally decided that he would quit his job to stay home, take him to therapy, and work with him one-on-one. We educated ourselves as much as possible about autism and learned that the prognosis is not as dismal as once feared, particularly if intervention is started at a young age.
So we took out a massive amount of student loans and he became a full-time stay-at-home father.

It's going to be tough for me to refrain from talking about autism all the time, because basically, for the past 2 1/2 years, my life outside medical school has been about nothing but autism. No parties, no extracurriculars, no dates with my husband, no get-togethers with friends, no long walks in the outdoors, no movies. Correction: on two occasions during 3rd year, I went to lunch with a couple of med school friends. Both times, I felt extraordinarily guilty because I should have spent that time at home helping my son.
3rd year was awful. Some rotations (OB) were worse than others. Psych was nice- I was home by early afternoon most days. Peds wasn't too bad- long 12-hour days on wards, but only 3 overnight calls. On each rotation, I would rush home to see my husband and son. I spent every evening and weekend providing therapy hours for my son. I didn't do the structured teaching his therapists did, but I did use a lot of unstructured play therapy. I tried to get him to communicate his wants, make eye contact with me, imitate hand and facial gestures, engage in simple pretend play. Some days were extremely frustrating, but other days he would make progress that was encouraging. One day he pulled me from the hall into his room, over to his playhouse and indicated that he wanted to play house with me. I nearly cried.
Family medicine kept us busy that winter- we had hospital rounds every AM and clinic every PM, but the attendings and residents were fabulous people who were a joy to work with. Still, that rotation was sheer misery for me because my son was going through a very difficult period at that time. He had basically become completely indifferent to me. Fortunately, he had developed a close bond to his dad, so that was some consolation. But it was so depressing to come home to a child who was never glad to see me and acted as if I weren't even there. Our play therapy sessions became fewer and shorter, since he wasn't paying attention to me anyway.
I started seeing a counselor around this time, just to have someone to talk to, which helped. Our marriage had also really started to suffer- my husband felt overworked and underappreciated as a stay-at-home dad. He felt that everyone blamed HIM for our son's problems, like it was his fault that he was autistic. He also felt really isolated, because he didn't know any other SAHD's and the SAHM's never invited him to their playdates or anything. He would take our son to community events like storytelling and Kindermusik but it was awkward because of his inappropriate behavior at times. People assumed our son was acting out because my husband was a bad father who didn't discipline him.
Our sex life suffered. I think we made love maybe once during an 8-month period. We knew we still loved one another, but we also knew we were both very unhappy.

Things got better, at least for awhile. We switched therapists and our son started doing better. I started my dreaded surgery rotation, but fortunately my best medical school friend was on the service with me. We used the downtime between surgeries to have long heart-to-heart talks, which did wonders for my mental health. Relationships with other women had always been very important to me, but that had completely fallen by the wayside once my son was born. My friend and I survived surgery by spending the long hours in the OR fantasizing about some of the more appealing male residents :censored:
We also covered for each other whenever possible, so we could grab a precious half-hour of sleep or family time. How I wish she could have been on every rotation with me!
My marital life improved exponentially. It didn't hurt that my libido was sky-high from the daily OR fantasy :censored: So even though I didn't see my husband much, we made the most of what little time we had.
My son was also doing better, making great strides in therapy. In fact, he started doing so well that the early intervention team said he had met his goals and cut some of his services.
My husband was still depressed over not having a job, but we decided that he was definitely going back to work after I graduated. In fact, if he got offered a job sooner, we could even leave 5 months prior to graduation and I could do away electives and vacation then.
I always knew I wanted another child, even though the risk of recurrence of autism was 15%. I had always envisioned myself having 3 kids. And since we had no nearby extended family and my son might never learn to make friends on his own, I thought a sibling was all the more important to him.