My second son was conceived during that memorable surgery rotation, during the first month we started trying. Once again, I was to be plagued by severe nausea for 6 months. I still had one more 3rd year rotation to go- internal medicine, of all things. Fortunately, I had great attendings and sympathetic residents who made sure I took care of myself and didn't complain when I left to throw up every single morning during rounds. I managed to do really well on the shelf exam and honor that rotation- God only knows how.
Now I was a 4th year and my goal was to design the easiest 4th year schedule in the history of medical school. Due to my pregnancy, this unfortunately didn't include radiology, but other than that I think I succeeded. Other than the sub-I and ICU rotations, the rest was elective and I deliberately chose the cushiest rotations.
It was a good thing, too. My son had started to really decompensate after his therapies were curtailed. My husband was getting really depressed and frustrated in his job search, which was leading nowhere. And I was so exhausted and nauseated all day, every day, it was all I could do to come home and collapse on the couch every evening. I would still try to do play therapy with my son from the couch, but he would ignore me and I was just too sick and fatigued to chase him.
As if that weren't enough, I developed gestational diabetes that required a very strict diet and daily insulin shots into my abdomen.
Of course, I was still anxious about the baby, though I did a much better job of trying not to worry about it. I still saw my therapist on a weekly basis and tried to keep things in perspective.

We were undecided on whether or not I should apply for residency. My husband was soooo tired of staying home that I knew he couldn't handle it any longer. He had done a fantastic job, but he had had enough. He was worried about his career- and rightfully so. And he didn't feel up to handling the stress of an autistic child during residency. But we couldn't just put a special needs child in just any child care setting. And we were having another baby. So we decided one of us would have to stay home and that person would have to be me.
So my husband kept applying for jobs, but couldn't even get interviews. It seemed no one was interested in hiring a guy who's been home changing diapers for 2 years.
Then we visited my inlaws in our hometown and saw how good my mother-in-law was with our son. She just seemed to have an instinctive knack for how to interact with him and he responded to her. Maybe it would help to have him close to her. This town had a residency program in my field and, lo and behold, it seemed quite family-friendly. Maybe residency would be tolerable with my MIL nearby. Besides, I was going to need a physician's salary in order to provide for my son's needs long-term.
So I interviewed at 2 programs and ranked only that one program. I knew that was the only possible way our family could survive residency.
Then came the thunderbolt. My MIL, who seemed the picture of perfect health, was diagnosed with Stage IV cancer. We were utterly devastated. She passed away 5 months later.
The match results were released. I had matched at my #1 (and only) choice, but what to do now?

In the midst of all this, Baby #2 arrived 5 weeks early. He spent a few days in the NICU, but I managed to rescue him and take him home where he belonged. The nurses wanted to keep him because he wouldn't drink his 30cc q 3h, but fortunately I knew the neonatologist and he signed him out to me when I told him that he was nursing fine. (Guess he's just another boob man, like his dad LOL.)
My mom came to stay with us and help out, which was good and bad. Good because she was a HUGE help and both kids really bonded well with her. My older son thought she was his own personal playmate. And the baby was colicky, so it helped having my mom there to soothe him so I could catch some sleep. But it's always tough living with your mom for weeks at a time- and even tougher if it's your mother-in-law. My husband still didn't have a job, so we were all home all the time driving each other nuts. Well, except for me- I was still in med school, but seldom had to actually go in during my research electives.
I graduated. It was anticlimatic. My MIL was in her last days and we knew it. We moved here, just in time to say our goodbyes in the hospital and bury her.
The baby appeared to be developing normally, though it was (and still is) too early to know for sure. However, he did have some minor medical conditions that made him extremely fussy. Like his brother, he still awakens frequently through the night.
My older son started to really regress after the move and after the loss of both his grandmothers (My mom had to return home 3000 miles away.) He needed me to be here for him and I knew there was no way my family could survive residency now. So I contacted my program director and just explained the situation to her and asked to be released from my commitment. Fortunately, she was very understanding. I felt awful about it, but I'm sure they'd rather have it this way than have me quit halfway through intern year.
And lo and behold- after a full YEAR of searching, my husband FINALLY got offered a job. It's not perfect, as the hours are long and the commute a long haul, but it's a good career move for him and he likes it overall. I am SO happy for him that he's finally back in the work force where he wants to be.
It was about time, too- we were getting to be in very dire straits. We had depleted almost all of our savings, maxxed out on student loans, and were about to lose our student health insurance. I actually went down to Human Services one day to apply for Medicaid for the kids, but the wait was too long, so I left. I wonder what they would have said about someone with MD after her name applying for Medicaid!
So here I am...now a SAHM, MD. I love it so far, but it's only been a couple of months. We'll see how it goes from here on out.

OK, so that pretty much takes us to the present. There is a lot I've glossed over and summarized and probably a lot that I've forgotten to mention.
So has anyone actually gotten through all this and read this far? Feel free to PM me- I'd love to hear from you. Also, if you have any specific questions, let me know and I'll try to address them if I can.
I've never done anything like this before and I'm not quite sure what prompted me to start this journal. I guess in part it's because I wanted to share my experience with others who are contemplating similar decisions. I also wanted to put everything down in writing so I can reflect on my history and hopefully come up with some answers for the future.

Thanks to all who've sent me PM's- I enjoy hearing from you and it's nice to know who's out there 'listening' to my rambling and ranting.
I just realized another reason why I'm keeping this blog: I don't really have any friends right now. My med school friends have graduated and moved away. My therapist is in another city and I have neither the time nor patience to find another one here. I did recently get together with an old friend here in town. We had a great visit and immediately confided in each other again, but I haven't heard from her again. She works full-time and has no kids. I'm a SAHM with two kids, so we really don't have much in common anymore. Still, I do hope we end up getting together again. Maybe I'll get my husband to watch the kids one weekend and go out with her.
Incidentally, it was interesting to hear her perspective on how I've changed. You see, when she last saw me, the last thing I ever thought I would become was a SAHM. I used to be an ultra-feminist, for one thing. When I was in my 20's, I swore I wouldn't have children and if I ever did, there was no way I would ever give up my career and be a housewife. Most of my interests used to be more guy things- watching football, hiking and camping. I have no clue about things like make-up or clothes or jewelry or hair styles- I've always had to defer to my female friends' advice when it came dress-up time for job interviews or whatever. I'm also guilty of forgetting my anniversary - this year, both my husband and I completely forgot it until my sister-in-law asked us about it 2 weeks later! In any event, my friend about fell out of her chair when she saw how much I had changed over the past decade.
Back to the friends issue- I've tried getting together with some moms' groups here. I chat with the moms I meet at my son's Kindermusik and gym classes, but I just don't feel like I have much in common with them. I don't mention that I have an MD- just instinct, I guess, it seems like it would widen the chasm. None of the moms I've met even have a college degree, much less a graduate or professional degree. Not that I'm being a snob or anything- it's just a question of differences in cultural background.
I know in the long-term I'll have to revisit this issue and find some way to have friends and a life outside my kids.
Another issue I need to deal with is my marriage. Now that my husband has a job, he's much less depressed and hopefully we can begin to work on our issues. Basically, the issue is we have no marriage right now. We're like live-in nannies for the kids- we both work our butts off taking care of them, me during the week and he on the weekends. We seldom even get a chance to talk, because he gets home late at night and spends an hour or so with our older son before going to bed. We don't sleep together, which is partly because I sleep with the baby, since he still wakes up to nurse at night. But we haven't had any physical intimacy since...well, since my 3rd year surgery rotation and that was well over a year ago! We've had droughts like this before and recovered just fine, but it's about time to start working on this one.
One thing's for sure: sex or no sex, I'm a lucky woman. My husband is the most caring, devoted husband and father anyone could have. The minute he gets home, he does everything he possibly can to help me out, whether it's laundry, dishes, diapers, taking out garbage, you name it. He never has to be asked to do anything. And he thanks me virtually every day for staying home with the kids, as he knows first-hand how hard it can be. Maybe that's another reason I can't relate to the other SAHM's- they constantly complain about how hard they have it because their husbands never help out at home.
Another big issue for me is deciding what to do with my career. Should I do residency or not? Should I switch to something with more benign hours like path or psych? Can I afford to NOT do residency? I'll be contemplating these and other questions on this site in the future.
But the biggest issue still remaining for me is how to best help my son. Frankly, that will influence all the other decisions I make about my life. But this post is too long already, so I'll address that next time.

I feel like the world's worst mom. I still can't bear the thought of what happened to my little baby yesterday. We were getting in the car - I was folding up my new double stroller with one hand while holding the baby in the other while watching my 3-year-old with one eye to make sure he didn't get out in traffic. Well, this new stroller is considerably bulkier than I'm accustomed to and I had to give it a good shove to get it in the trunk. At that moment, the unthinkable happened. My baby lunged backward and fell headfirst onto the asphalt. The thud his tiny little head made as it hit the asphalt is the most sickening sound I have ever heard and I have relived this scene over and over and over again since then. He lay there for a second or two, then started screaming. I scooped him up, yelled to some passersby "I need help!" Fortunately, there was a small hospital right next door. Two nice women drove us over there- my 3-year-old screaming as loud as the baby by now. We rush into the ER, go straight to triage, and get in a room, baby screaming all the while. While waiting on the physician, the baby finally quiets down after about 20 minutes of screaming. The receptionist managed to find a toy to keep my older son occupied and he has calmed down as well. So finally the ER doc comes in and I take an instant dislike to him. Young male in his 30's or so- typical arrogant a**hole. He spends all of 30 seconds looking at the baby, pronounces him fine, and orders us out of there. When I protest by telling him the baby fell at least 4 feet headfirst onto a hard surface, he smarts off to me, says "Hey, you came here for my professional opinion, this is my opinion, your baby is fine, go home." What the $%^&**? Pardon me, but when we're talking about my baby, you better be darned sure your opinion is right.
I can understand why patients want to sue doctors. Heck, I think this guy's got it coming. It's a**holes like this guy that give us all a bad name and have created the current legal climate that makes it darn near impossible for any of us to practice medicine the way we would like to. All the man had to do was take a few minutes to SIT DOWN, LISTEN to my concerns, reassure me, tell me what signs to look for, and what to do in case of any changes. In fairness, the nurse did do some of that later, but frankly the doctor should have spent more than 30 seconds with an infant with a head injury and his distraught mom.
When I spoke to the nurse afterward, she asked me if I were a nurse, probably because of my line of questioning ("But how do I know he isn't just having a lucid episode prior to losing consciousness from an epidural hematoma? What signs do I need to look for to make sure he doesn't develop a subdural over the next few days?) I confessed I had an MD and she was even nicer to me and asked me if I wanted to speak to the physician again. What the %^&*(? Because I'm a physician, I'm entitled to more of the doctor's time, but if I'm just hysterical mom Jane Doe I'm treated like crap? I thanked her and told her I had nothing more to say to the physician. I actually had to really hold my tongue here, as he deserved a tongue lashing, but it wasn't this poor woman's fault and I wasn't about to take it out on her.
So we went home and I stayed up most of the night with the baby. He had some happy, alert periods, but also has periods where he's more irritable than usual. He's vomited once since then, and it's now been over 24 hours. His pupils are equal, round and reactive to light, reflexes intact, he appears to move all limbs equally. He nurses normally. He may be a little sleepier than normal, but he's stayed awake for over 2 hours at a time, so it's not like he's lethargic or anything. I've called the pediatricians and they said if I'm worried about it, to take him to the Children's Hospital ER. I'm not sure what to do at this point- I will probably just watch him tonight and see. I hate to drive him all the way across town and wait all night in a crowded ER if they're not going to do a head CT. I can monitor everything else myself, but I'm not able to order the CT scan.
I just can't get over the fear that he has a traumatic brain injury and it's all my fault. I really wish I could get that CT so if it were negative, it could put my mind at ease. And if not, we'll know. We'll see. I pray everything will be ok. Either way, I know I will never forgive myself. And I know I will worry about him for the rest of my life.

Thanks so much for your messages of support- that means a lot to me. So far, the baby seems to be fine and it's now been over 48 hours. According to my husband, he is acting perfectly normal today (I'm far too distressed to be objective about it.) I mean, he's *probably* ok....but I'm not. I am so worried that he will turn out to have a subdural hematoma with TBI...I know these may manifest several weeks later. I realize they're most common in the elderly, but infants are also susceptible due to larger gaps in the subarachnoid space compared to adults. I guess the bottom line is I don't see how a baby can fall headfirst 4 feet onto asphalt and *really* be ok. If I drop an egg that far, it breaks- guaranteed. It's not like he just rolled off the couch onto carpet or anything. I mean, I'm thankful he seems to be ok, but I just can't help but worry that he's really not ok. I'm going to take him in for a well-child visit on Tuesday and hopefully get some reassurance from the pediatrician. I wish I could just relax and not worry, but I just can't help it.

First things first: it's been over a week, but the baby seems to be fine so far, thank God. Thanks so much for all the messages of support. I LOVE my baby's new pediatrician, whom we met for the first time this Tuesday. I've never been happy with any of the pediatricians my kids have gone to, but now I've finally found someone who seems to really care and who will LISTEN to me. She doesn't have kids herself (regretfully), but she seems to understand being a mom far better than any other pediatrician I've ever seen. She would have referred the baby for a CT scan had I insisted on it, but we decided that it would be an unnecessary burden at this point. She did say to call back anytime if I became concerned or changed my mind and we could still do the CT then. So I'm reassured, for now.
I like her so much that I plan to take my 3-year-old there for a well-child visit, which he hasn't had in almost 2 years! Doctor's visits were just too difficult with him back then, screaming and tantruming and going berserk, so I stopped taking him after his 18 month visit or so. Whenever he was sick, I would just ask one of the pediatric residents to take a quick look at him. He's much easier to deal with now- in fact, he did great at the baby's visit. We were there for over 2 hours total and he was very well-behaved most of the time.
It's been a busy week- I also had a meeting with the local school district to discuss my older son's testing and plan for his services. As expected, this school district didn't have much to offer. They offered placement in a special ed preschool, which I refused for a number of reasons. First of all, he's way too high-functioning for a special ed class. Second, the school is on the other side of town, a very long haul. Third, and most importantly, my husband and I have committed to doing a family-based therapy program with him and the only time my husband is home is in the AM. I did agree to try him in an afternoon playgroup that they offer for speech-delayed kids. I thought he'd get some of the benefits of preschool that way without all the hassle. We already do various Mommy&Me type outings several times a week with typically developing children and the older he gets, the better he does in those settings. So we'll see how this new playgroup goes and go from there.
If you were a casual observer of my son right now, you probably wouldn't immediately guess he has autism. He's come a LONG way in the last 2 years. He doesn't tantrum any more than the average 3-year-old and he seldom spins wheels anymore or engage in other repetitive, sterotyped movements (though he does have a huge obsession with trains). However, if you tried to talk to him, you'd probably find it odd that he doesn't answer you. Or if he does answer you, it may be with a complete non-sequitur such as a scripted quote from a Thomas the Train video. Even if he did answer with an appropriate response, he wouldn't look at you. If you tried to have a conversation with him, you would quickly find that impossible, as he would launch into a complete verbatim recitation of the "Little Engine that Could". In short, he has so-called "high-functioning autism" or Asperger syndrome. His IQ is above average, his language knowledge is normal, but his social and communication skills are significantly impaired. He also has some delays in self-help and feeding, as well as some sensory issues. For example, he still refuses to feed himself with a spoon or drink from a cup. Still, he's now considered to be on the milder end of the autistic spectrum because of his cognitive and language strengths. Maybe it's because of all the early intervention we did with him.
I think he's brilliant. He knew all his colors and shapes by 15 months, could identify all the letters of the alphabet and name all 9 planets in a row by age 2, could name all 50 states on a map and count in 4 different languages by 2 1/2. On the other hand, he still doesn't say hi or wave bye at age 3. And he still has zero interest in peers, unless they happen to have a train and then he's only interested in getting the train. Fortunately, he loves his little brother and he has a close relationship with us, his parents (though he may not show it the same way other kids do.) He no longer has any serious behavioral issues- he handles transitions very well, even when we have to leave his beloved train table at the bookstore (while all the neurotypical kids are screaming and tantruming and biting their parents, LOL!) He's a very gentle, mild-mannered, almost *too* passive little boy- never hits anybody, but never retaliates when others hit him, for example. He has a strong tendency to retreat into his own world, e.g., just sit playing with trains in a corner by himself for hours on end. We hope that the family-centered therapy we're doing with him will eventually remediate some of these core social and communication deficits.
Yikes, this post is way too long already and I had several other things on my mind tonight. Guess we'll save it for another day. I am taking my old friend out to dinner this weekend for her birthday, so I'm really looking forward to getting out for some adult conversation.

It's been a nice weekend. We've used our new stroller a lot to take the kids on walks- something we've not been able to do in years! Our 3-year-old walks most places, but gets tired and then wanted to be carried- but at 42 pounds, he was getting really heavy. So we bought a stroller with a higher weight limit that also gives him the option of standing if he wants to and that has really changed our lives! Now maybe I can FINALLY work on losing some of that post-baby weight!
I met my old friend yesterday for a walk and then we went to dinner for her birthday. It was really nice. That's the first time I've left the baby in months, but fortunately he did fine with my husband at home. He even took a bottle :-) Hopefully we'll be able to get out more together. As for going out alone with my husband, now that is still a pipe dream...maybe someday? Today was his birthday and we went out to eat, kids in tow. Fortunately, the baby slept and the 3-year-old did great, so at least we didn't have to rush our meal- last time we tried this, we had to leave in the middle of the meal.
I'm contemplating my future and trying to think about which residency to do. I thought that I could stick with IM, then go into a more laid-back specialty like allergy or endocrine. But I'm realizing that, in my current situation, my family probably wouldn't survive an IM residency. So, other options....

1. Psych- I considered this one strongly during med school, especially child psych with a focus on autism (though at least 2 years of gen psych are required first). Should be an obvious choice for me...but I have a really tough time dealing with the adult psych, particularly all the substance abuse, sociopaths, borderline personalities, etc. on a daily basis. It's just frustrating and emotionally draining. As for child psych, if I could just focus on autism, I would LOVE it- but unfortunately most of child psych is NOT autism and a lot of it is dealing with parents. On my psych rotations, it drove me crazy dealing with all the dysfunctional parents and it made me sick seeing all the horrible emotional turmoil these kids were suffering through. It's not for me- I would take my work home every day and be unable to get a reprieve.

2. Developmental peds- Requires a 3-year peds residency first. I thought about this one hard as well. But developmental peds has a lot of the same issues as child psych as far as dealing with difficult or abusive parents. Besides, I can't see myself doing 3 years of general peds. I liked taking care of the really sick kids on wards, but I hated clinic- looking in screaming kids' ears all day long was just not for me.

3. I must have been born with two left hands- in any event, my manual dexterity leaves much to be desired. I'm terrible with procedures. Also, I'm not good at split-second decisions - I like to have lots of time to mull over decisions, so I would be utterly useless in an ER. So that R/O EM, gas, ophtho, ENT, as well as surgery and OB (not that I'd ever consider the latter anyway).

4. Derm- probably R/O by my lack of manual dexterity alone, but aside from that, it's a nearly impossible match.

5. Rads- thought about this one, but never did a rotation in it. Interventional involves procedures, but you don't have to do much IR in practice if you don't choose that route. I could just sit in a darkroom reading films all day. Hmm, sounds really exciting...that's what I wasted $150K on medical school for? Maybe I should still consider this one, for lifestyle alone. In fairness, I've never tried doing it, so maybe I would like it? But it is a very tough match, almost as tough as derm. Plus, I'd have to somehow get through a prelim year first, which would be very tough right now.

6. Path- similar to rads. Easier match than rads. No prelim year required. But do I really want to spend the rest of my life looking at slides under a microscope? Again, I never did a path rotation in med school, so I just don't know. Maybe path would provide a lot of the intellectual stimulation that I liked about IM without all the overnight call and other stressors?

7. Preventive medicine- don't know much about this one. Requires a prelim year + 2 further years, 1 of which is spent getting an MPH. Hah, like I don't have enough degrees already! Not sure what the job prospects are in this field. It also encompasses the field of occupational medicine, which is a nice 9-5 life, from what I gather. Need to research this one further.

8. PM&R - I should have done a rotation in this during med school. Apparently, there is an option for a pediatric PM&R, which seems like it would be really rewarding. Prelim year required either way.

9. Medical informatics- there are some post-graduate training opportunities out there for physicians, but I don't know how the job market is. Sounds interesting and a good fit for my background, but then I wouldn't *really* be a doctor.

I think that about covers it. I've left out FP, but basically it's like IM without the option to specialize. I loved my FM rotation, but I didn't like how the FP residents were treated by the surgical and OB residents. The last thing I want to do is go back and be on intern on a surgical or OB service, God forbid!

When I think back on what brought me to medical school in the first place, I realize it was taking care of sick adults. That makes me a natural fit for IM. And I really liked both my IM and FP rotations in med school, even though I had a lot of family and personal issues at the time. But...it's not just about me anymore. My son comes first. His well-being is more important to me than my patients will ever be. It wouldn't be fair to either my family or my patients for me to practice medicine right now, at least not in the current scheme of things.

But I have to repay my loans and provide for my kids' future somehow. So I need to look at alternatives, even if they're not necessarily what I originally envisioned myself doing with an MD. So...I think my plan should be to further research rads, path, PM&R, medical informatics, and preventive medicine. I need to find some way to spend time in each of these specialties.

I also need to hurry up and register for Step 3 before I forget everything I learned in med school. Also, you have to take all 3 steps within 7 years of one another, so I need to get that out of the way before I find myself in the unenviable position of having to retake Step 1 :yikes:

First off, thanks for the PM's- I have read them, but have fallen behind on replying. I plan to catch up this weekend.
Now- I'm struggling with an issue. I KNEW this would happen and don't know how to handle it. One of the moms I've met at my son's activities has solicited me for some medical advice and I don't know how to respond. She found out I had a medical degree, even though I made a point of emphasizing that I haven't even done residency yet and don't have a license. Still, she's asked me for my opinion on a couple of concerns. Her email's been in my Inbox for a couple of days now and I need to respond.
What to do? I like this mom, so I need to be careful here. I don't want to come off as pompous or conceited and I'm afraid that's exactly how I'll sound if I just say "Sorry, can't help you, I'm not a licensed physician and anyway, I don't have your chart and haven't done an H&P on you." It seems too snide to just tell her to talk to her own physician. One of her concerns involves some psych issues, so I really need to be sensitive here.
I've considered just searching for some articles related to her concerns and sending them to her, maybe suggesting she share them with her physician. That would involve some extra work for me, which I guess is ok just this once. I really don't know the answers to her questions and she hasn't given me enough details to even begin to research the specific answers.
It's amazing what a difference those two initials make in people's perceptions! I mean, I haven't done a day of residency training and probably know much less medicine than most nurses. Apparently, no one understands that RESIDENCY is where we really learn medicine.
Guess I'll have to do a better job of keeping my background under wraps. But what am I supposed to say when someone asks "What did you do before you had kids? Oh, you were in school? So what were you studying?" Maybe I should say "biomedical sciences" or something obscure like that...