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.

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...

It's been a hectic week. First the baby was sick with a croupy cough, then my 3-year-old got sick. So after sleeping most of the day, my 3-year-old is now wide awake in the middle of the night, which means I'm up too. All I can think is "THANK GOD I'm not a resident!" I don't know how the resident moms out there handle it, but I know I couldn't. Stronger women than I, no doubt!
My older son started his playgroup last week and I think it's going to go well. The other kids have speech delays but are otherwise normal, no other autistic spectrum kids. There are 6 kids and 2 teachers, so the ratio is fantastic. And I get to watch through a window if I want, so I can see exactly how he's doing. I think it's exactly what he needs right now- but I just wish it met more than one hour a week! I do take him to other activities with typically developing kids, but there I always have to stay with him to facilitate his involvement. If I were to leave him alone, he would just withdraw into a corner, ignore everyone, and play with trains for hours on end. The only other option would be a special ed preschool, but he is way too high-functioning for that. Once he hits kindergarten age, he would have the option of going in a regular classroom with a one-to-one aide, which might be a good solution. However, we'll have to move to another school district by then, because the public schools in this area are notoriously horrible. We'll see...it's still a couple of years in the future, so we'll have to see how he's doing by then.
One thing's for sure: I made the right decision by quitting to stay home. My son is now doing better than he has ever done in his life. Yes, he is still autistic, but his behavior has improved significantly over the past several months. We are working on implementing a new therapy called RDI (Relationship Development Intervention) to address his core social and communicative deficits and are excited about the changes we have seen already.
My husband is happier than he has been in 2 years. His job is far from perfect, but he's just so happy to be back at work and he is sooo thrilled to see the kids whenever he gets home from work.
I'm happy that I get to be here for my kids. Every day, I thank God I have this opportunity to share every day with them. Now, some days I confess I wish I had help with the baby- he's high needs and it would be nice to have a grandma or someone around to soothe him for an hour or so once in awhile. But I still wouldn't trade staying home for anything in the world. In fact, right now I'm thinking I just want to stay home forever, but I know that's just not an option. Still, I did some research and determined that I could probably swing it for a few years, though my student loan debt would continue to rise. I can get a 3-year economic hardship deferment, then make interest-only payments for 10 years, which amounts to about $400 per month. (Of course, the interest continues to accumulate...at least it's only 2.8%, but when you're talking a balance of $150K, that's still $4200 PER YEAR!) After 10 years, I'd have to come up with about $750 a month for the next 20 years. However, by then my youngest would be 13, so surely I would be working at least part-time by then. (Of course, kids get more and more expensive as they get older and then there's college to think about...)
And that's assuming we don't have any more kids, which will probably be the case. I'd love to have a big family, but the fact is, we don't have the resources, neither family nor financial. Besides, both my pregnancies were high-risk (PPROM, gestational diabetes, pre-eclampsia) AND I'm now over 35, not to mention my children are at higher risk for autism. And without family help, there is no way we could manage more than two kids. So, as much as it saddens me, this baby will almost certainly be my last. So I really need to try to enjoy every moment while it lasts.

I've met another mom that I think I'm going to really like. We met at one of my son's classes at the local kids' museum. She has a really sweet 3-year-old and seems to be a really nice person. She even knows I have an MD but it hasn't changed her attitude toward me at all, thankfully. She said she doesn't really know a lot of people with kids, so she'd love for us to get together sometime. Unfortunately, she lives on the other side of town, so that kind of makes it tough, but we're going to try to get together sometime next week anyway.
My 3-year-old's train obsession is driving me nuts right now. From the moment he wakes up until he goes to bed, it's all about trains, trains, trains. It's been this way for 2 years and seems to be worse the last few months. I can't seem to get him interested in anything else. Hopefully this will pass, eventually!
My husband took today off work so we had a nice "weekend" day in the middle of the week. Enjoyed this beautiful October weather to take the kids for a stroll along the river. It was really nice.
Last weekend we took the kids to the local amusement park, the same one where I hung out when I was a kid, but had not been to in 23 years! It's amazing- a lot of it was still the same, but it all seemed so much smaller now. It was really emotional seeing my child riding the same rides that I rode when I was a kid. This is an especially big deal for him because he used to be utterly terrified of motion. For example, even though he has a major train obsession, up until a few months ago he wouldn't even set foot on a train, much less ride on a moving train. He still won't go on merry-go-rounds or bumper cars or most other rides, but last weekend he and his dad went on a log ride and a train ride together. The log ride was actually kind of scary, my husband said, because it went through a long, pitch dark tunnel. Then, he went on a kiddie boat ride all by himself!! It was so cute, seeing him on this kiddie boat ride, happily riding around in a circle in the water, just like all the other kids.
This has taught me a lesson: quit worrying about insignificant things. His occupational therapists used to tell me that he had sensory integration disorder and gravitational insecurity and all kinds of things, but I'm realizing now that that's ok. He used to be terrified of all rides, but now he likes a few. Eventually, he's bound to like even more. Similarly, he's a picky eater, preferring only about 5 foods and refusing to feed himself with utensils. Recently, I've been successful at getting him to feed himself a few bites of his cereal with a spoon. I still feed him 80% of it, but it's progress. I still can't get him to try new foods, but he did try a new type of cracker at one of his preschool classes and that is now his new favorite food. So I'm going to try to relax and worry less about things like that.
What's most important is his social and communicative skill development and that's what we're doing RDI for. I do wish I could find more opportunities for him to be around peers. I don't want him in a formal preschool, but I wish I could find more things that we could do together with other kids. Hopefully I'll keep meeting other parents and we can start having frequent playdates.
I'm trying to study for Step 3 in my spare time and I must confess it does make me somewhat nostalgic for medicine. Right now, I could never give up being a SAHM, but maybe some day when the kids are older...Guess it all just depends on how my older son is doing at that time. I wonder if any residency program will accept someone who's been at home for years and years? If I go back to IM, surely SOMEONE would take me, at least my alma mater (which has mostly IMG's). I realize rads would be out of the question unless I got into some serious research in the field and made a lot of connections, so I guess we can write that one off for good. Don't know about path- it's getting more and more competitive and who knows how it will be in a few years when I'm ready to apply? I've looked into preventive medicine and there are only a handful of programs nationwide and many of them now require or strongly prefer completion of a residency first, so that would defeat the purpose for me. Well, first things first...let's get that Step 3 beast out of the way!

Ugh, sick child AGAIN! My baby's been vomiting and had diarrhea for 3 days. The first day, he vomited at least 20 times- then I lost count. The second day, he kept on vomiting and the diarrhea started. Today, I thought he was getting better, but he had 4 more loose stools and then started throwing up all over again. He doesn't appear to be dehydrated- mucus membranes moist, good capillary refill, he cries tears, and seems quite alert and playful when he's not vomiting or napping. I wish he would take Pedialyte, because I think that would cut down on the vomiting, but NO! He only wants to nurse, nurse, nurse! Hopefully, he'll feel better tomorrow. I'm getting cabin fever and REALLY want to get out of the house and enjoy this gorgeous weather we're having. Hopefully he'll feel better tomorrow, poor little guy.
I received an interesting email from the residency program here- they asked me if I wanted to come back and start next July. So if I wanted to go back next year, it sounds like it would be no problem. If only it were that easy! In my heart of hearts, I know that my family can't handle this right now. First I have to see how my 3-year-old develops- then- maybe- when he starts kindergarten, we might be able to make it work. That's assuming my younger son turns out to be ok. But then what happens when the kids get sick? How can I ever work a job where I will never have the flexibility to leave if my kids are sick? When I'm on call, I can't just leave the hospital to come home to tend to a sick child. OK, well maybe as an intern I could sign off to my senior and go home in a true emergency, but only in a true emergency, not for your everyday run-of-the-mill gastroenteritis. And the truth is, I really NEED to be available to the kids because my husband just can't handle it by himself and we have no one else. And it's not everyday you find a nanny who can handle a child on the autistic spectrum. Plus...I just WANT to be here right now. I know this is what's best for my family and I can't imagine doing anything else in the near future.
The other day, when we took the whole family for a walk along the river, I started thinking that
I still can't believe I'm in this SAHM role. My husband and I used to spend many long hours in this park when we were first dating. We would take long walks along the river, get up early to watch the sun rise, make out on the piers, and sit up talking all night long. I was 18 years old and I knew everything- or so I thought! Now, 16 years later, here we were- older, wider in girth- walking those same paths with two beautiful kids in tow. Wow.
I never would have imagined it back then. Me, Ms. mega-feminist, now a SAHM? I was a walking Betty Friedan in my younger days. It seems even more inconceivable that I actually ENJOY this. I need to go back and re-read "The Feminine Mystique" because right now, I have trouble imagining why anyone would be unhappy staying home. Perhaps it makes a huge difference that I've only been doing this a short amount of time. Also, that I'm older than most moms were in the 1950's and that I did have a LIFE before becoming a mom. Perhaps having the medical degree- even though it seems to be the bane of my existence right now due to student loan payments- gives me some feeling of accomplishment that many other SAHM's may lack. Maybe it's knowing that I am a SAHM because I CHOSE to do this for the good of my family. Maybe I'll feel differently over time. We'll see.

Well, just when I thought my 3-year-old was doing super-great, awesome, fantastic, we suffer a major regression. I don't know what's caused it, but we've had some serious sleeping problems and behavioral issues the past few days. He doesn't appear to be ill- that was my first thought, of course, as his behavior often becomes worse when he's not feeling well. In retrospect, it probably started a couple of weeks ago, when he started becoming more upset at little things and even more obsessed with trains than usual. Then he started waking up once or twice a night demanding that all the lights in the house be turned on. I figured he was starting to have nightmares or maybe developing a fear of the dark. Then he started having more temper tantrums over the littlest things. Saturday was the worst. When we left a store where he was watching the train, he proceeded to have what is probably the biggest meltdown he has ever had. He screeched and screamed and kicked and thrashed non-stop for 45 minutes. It's like he wasn't even in this world- like he was having a psychotic break or something. We used to have similar tantrums when he was 2, but I'm not sure we ever had one this bad. I have to wonder if perhaps he's in pain or something and just isn't able to communicate that for some reason. I have noticed he's been mouthing objects like crazy, which he doesn't normally do- but again, that could be either a sign of autism or a sign of illness, as autistic children often mouth inappropriately (though he hasn't really done that in 2 years either).
Today was a little better- he woke up way too early at 4:45 because he was wet, but he did ok the rest of the day. We visited my father-in-law and then we went to a Fall Festival at a local church. He did ok with transitions- he loved the inflatable slide, but when I said it was time to go, he protested mildly, then left without making a scene. So maybe whatever it was is getting better. I just wish I knew WHAT was making him this way.
My husband and I both got really depressed yesterday when we were dealing with the meltdowns. We had been considering ourselves so lucky that our son was doing so much better, but this was a real set-back. My husband is also stressed out because of a personnel conflict that has arisen at his job. I hate that for him- he is the nicest, most easygoing guy in the world, but it seems there is always SOMEONE at every job who is utterly miserable in their lives and out to make everybody else miserable too. Since this person has seniority, my husband's in a tough predicament- he can't really complain, since he's the new guy on the block and this other person has been there for years and years. Oh well, guess he'll just have to deal with it. Hopefully it won't be too bad.
I've also been in touch with our state's early intervention program to get some home therapy for the baby. Though he seems normal socially, he has some language and motor delays and it appears to be enough to qualify him for therapy paid for by the state. I'm really not too worried about him, but given the family history, it always pays to be on the safe side. The sad thing is that my older son- who really NEEDS the therapy- can't get it, since early intervention only goes to age 3. At age 3, they are supposed to get their therapy through the school district, but this one won't provide what he needs. Of course, I could always file a due process, but that takes years and years and meanwhile, he still gets no services. The one thing I am doing is interviewing a young college student next week to work with him at home, just a few hours a week. We'd have to pay for this out of pocket, but if he likes her and she's good, that's fine, we'll pay it. She's experienced with Relationship Development Intervention, which is what we're working on with him, and I thought it would be nice to have her here a couple of hours a week, just to do some play therapy with him and maybe even give me a chance to get some work done around the house.
I can't practice medicine. Especially at times like this, when my son's behavior decompensates. I cannot be in a career where I have to put his needs behind those of my patients'. I have to be here for him and advocate for him. I'm just going to have to resign myself to the fact that my career goal in the near future is just to earn $750 a month to make my student loan payments, period. And my husband and I will just have to live off his salary. It's modest, but it's a lot more than either he or I grew up on. We had always hoped to be able to do better for our children than we had, but that may just not be possible. Well, it *would* be possible if I practiced medicine, but that would mean that I would have to be gone from the family between 40-80 hours per week and that is just not feasible right now. Perhaps that will change, eventually. We'll just have to wait and see.

Wow, long time no post here. We've been out of town meeting our RDI consultant,who is AWESOME! We're really looking forward to implementing this therapy with our son. It was a really long trip- 9 hours each way with 2 little kids! But it was definitely worth it.
My older one is still having an increased frequency of tantrums compared to before- usually I'm able to ward them off, but sometimes, maybe 3-4 times a week, they escalate into a full-scale kicking, screaming fit. I know neurotypical kids have tantrums, too, but his are more intense. Strange thing is, after the tantrum, he's back to his usual, normal self. I can't seem to identify a trigger for the tantrums. Frankly, I'm mystified- he went nearly 6 months with almost no tantrums and now, all of a sudden, he's back worse than ever. Hopefully he'll get over it.
I'm trying to study for Step 3 on the side, though it's hard to focus when I have so much else going on. I am strongly considering a switch to pathology, even though it was never my goal in going to medical school. I think that intellectually it's certainly interesting. Problem is, I'm a people person, not a lab rat- so I'll have to see if I can tolerate dealing with frozen sections and microscopes rather than living, breathing patients. No, it's not my first love, but it's about the only specialty I stand a chance of matching in that would allow enough time for my family, even during residency. Also, I could see myself developing a research interest in pathology of the autistic brain- I've read a few studies indicating that autistic individuals have some neuropathologic abnormalities, particularly in the cerebellum, amygdala, and hippocampus. I think that perhaps I might go through the match next year to start in 2007, when my older one would start kindergarten. The baby would be 2 1/2, so he could easily go to daycare by then. He's very social and already gets bored staying at home with us, so I know he would like daycare if we found him a good program.
But first, I need to spend some time with a pathologist to see if this is even something I would like. I'm going to try to arrange this over the holidays, when my mom will be here staying with us. Of course, becoming a pathologist would mean I will never be able to go back to that inner city clinic and take care of the poor working class diabetics that I always dreamed of helping. That thought saddens me immensely. But if I can help my son remediate his autism, then it will be worth it.
Just got my student loan payment book in the mail today. It seems I neglected to file for an economic hardship deferment on time, so I may have to make that first payment until they process my deferment. UGH! It's so depressing seeing how my interest on the loans is adding up exponentially, but I just have to forget about that and do what I have to do.

I'm shell-shocked and in tears over Kris' news. I've never met her, but I've followed her postings for several years, even before I got on MomMD. How my heart aches for her and her family. I just can't bear the thought of her kids growing up without their mom. I hope she turns out to at least have something with a decent chance of cure. It occurred to me that she actually fits the profile for primary mediastinal B cell lymphoma, an aggressive subtype of Non-Hodgkins lymphoma that most commonly occurs in women in their 30's. Most commonly presents with SVC obstruction, SOB, and cough. It's not the best form of NHL, but 5-year survival is somewhere around 60%, which would at least give her a decent fighting chance. But, of course, this is sheer speculation on my part. If I had my way, I'd want her to have something completely benign, like lymphoid hyperplasia.
It is so difficult to envision another mom my age facing the possibility of dying from cancer. It really hits home with me because it's something I worry about all the time anyway. Above all, I worry about what would happen to my older son if I weren't here for him. Kris has mentioned that one of her children probably has mild Asperger syndrome and I know she's recently faced some difficult issues with her pre-teen daughter as well. These kids need their mom and it is killing me to think of the possibility that she might not be there for them. Even if she ultimately beats this thing, she's probably going to be really sick and fatigued and nauseous for a long time. I hope she has a lot of support from family and friends to help. I wish I could help in some way.

OK, I really need to vent tonight. MY MOM IS DRIVING ME CRAZY!! :banghead: :banghead:
She's visiting for an extended period and I am genuinely grateful to her for coming over to help with the kids. However, she is driving me insane. She has this know-it-all attitude about absolutely EVERYTHING, even things she doesn't have the foggiest clue about. She criticizes everything I do, blames all my kids' problems on my poor parenting, and has the solution to everything. Her solution to my son's autism: just put him in daycare around other kids. She never, ever ever listens to one word I say nor gives me credit for anything whatsoever. For example, I tried to explain to her that, at least on the issue of autism, I am certainly qualified to make decisions about my son's treatment. I've read virtually every paper out there, especially on treatment, have written a number of lengthy reviews of the literature, and have even been asked to serve on a state committee for the treatment of autism. She, after speaking to one or two retired friends who used to be special ed teachers, now claims to know more than I do. In fact, the manner in which she approaches the subject is downright hateful. I'm sure she means well, but all she ends up doing is insulting me and everything I do. Then she turns around and says that I am the one who is being overly belligerent in my responses to her "suggestions".
We've faced these sorts of problems for most of my adult life- ever since age 18 or so, when I realized that Mom is not always right. In fact, she's wrong a great deal of the time. She means well, but she has a lot of ridiculous antiquated ideas that no amount of evidence will dispel. She doesn't take an evidence-based approach to anything. Yet she instantly renders an opinion about absolutely EVERYTHING and EVERYBODY. Actually, it's not even stated as an opinion- it's always stated as categorical fact. Before I had kids, I didn't mind it so much- I just sort of let it go in one ear and out the other. But now, it's impossible to just ignore her because I have to hear it ALL THE TIME.
She insists that, since she was a schoolteacher for 40 years, she knows all about children and their development. She knows what toys they need, what books they need, what foods they should eat, and how to discipline them. She actually forbid me from buying the toy that I wanted to buy my baby for his first birthday because she thought it was inappropriate. So I had to get him something else. This is insane! I can't even get my own kid what I want to get him for his birthday?!
And if I hear her say one more time how wonderful it is that my son plays with trains all day long, I think I will scream. She bought him a bunch of extra trains and says she thinks it's fantastic he can occupy himself for long periods of time with his train set. Never mind that all he talks about all day long consists of scripted quotes about trains from books and movies. Never mind that he can't carry on a conversation about anything whatsoever, so consumed is his mind with trains. Never mind that I spend every possible second of my life playing with him, trying to get him more engaged with people and also encouraging a broader variety of interests in other toys. She just doesn't get that this is a classic manifestation of autism: an "encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus" (That's from DSM-IV) I've given her books and journal articles to try to explain, but she finds fault with all the authors because she knows everything better than they do.
So...maybe I should just ask her to leave. I really, really hate to do that, because I really want my kids to have a relationship with her. Especially since she's the only grandmother they have. If, God forbid, something should happen to my husband and me, she's the only person that they'd have left. I shudder to think of her raising them, but since she's the only person we have who genuinely cares about them, there really isn't a choice.
I guess I need to try to make this work, somehow. Maybe I'm at fault somehow as well.
OK, off my soapbox now. Other than my mom, my thoughts this weekend have been with kris. I can't stop thinking about what she is going through right now and I know my problems are ridiculously petty compared to hers. Someone on another thread posted that quote about "There was a man who complained because he had no shoes until he met a man who had no feet". I'm going to print that off and keep it where I can see it every day.
So, applying this to my situation...what if I didn't have a mom anymore? Or what if she were seriously ill and bed-ridden or impoverished and living in a housing project or an alcoholic or had schizophrenia or CHF or any number of other problems? I am so lucky- my mom is in good health, well-educated, financially stable, and involved with her grandkids. Instead of lamenting the loss of my dear sweet MIL, I really need to try to come to some kind of understanding with my mom. She was kind enough to leave her home and friends and fly thousands of miles to stay with us in this crowded apartment, just to be with me and the kids. That's pretty awesome, when I think about it. I guess we just really haven't had a chance to sit down and re-connect with one another. Life is always so stressful around here- I have my hands completely full with my screaming high-needs baby and my autistic 3-year-old. Then when my mom starts criticizing everything I do- well, that's just the last straw. We need to find some way to sit down and talk, like we used to before the kids. Things aren't right between us and they haven't been in many years. If this is important to me, I need to approach this subject with her and hopefully we can straighten things out.
Well, I apologize for all the ranting and raving here today. I really needed a place to vent and I appreciate this opportunity.

Wow, it's been a long time! Things have been so crazy around here lately. First the holidays, then the kids were both sick and meanwhile we're into March! Fortunately, my mom was still here when the kids were sick. I don't know how I would have made it otherwise. First the older one had chicken pox, then exactly 2 weeks later the baby got it too. Then, no sooner had he recovered from the chicken pox, he got RSV. Now, everybody is FINALLY healthy again, thank goodness! Whew!
So what have we been up to? Well, unfortunately it didn't work out with my mom. She did end up staying the entire time she'd planned, but she and I never really connected. She basically just played with the baby most of the day, which at least freed up more time for me to work with my older son. I had hoped she would bond with my older one more, but she just found him too difficult to deal with. And the baby is so sweet and sociable, I guess it's human nature to prefer his company to that of a withdrawn, sullen 3-year-old. It's unfortunate because the last time she was here, they had been very close, but now it appears she just wouldn't make the extraordinary effort required to become close to him. Why bust your chops trying to drag the older one away from his trainset when there's a beautiful smiling baby just begging to play with you instead? Unfortunately, this has been a pattern everywhere we go, so our older one really has no relationship with anyone except us, mom and dad. I had hoped my mom would understand the importance of trying to connect with him, but it seems she just wasn't able to do it. I understand. It's very easy to feel rejected and offended when a child resists all your best efforts to engage him. The difference is, that only makes ME try harder and in this manner, I have been successful in getting him to bond with me.
The amazing thing is I don't have to do anything with my younger son and he still thinks I am the greatest thing in the world. When my mom was here, he would stay with her and play happily all day, but the minute he heard my voice, he would start crying until I picked him up. I mean, I could totally ignore him and he would still love me. Amazing! I'm shocked at the difference between him and his older brother. A lot of things have become more clear to me now that I'm experiencing the development of a (presumably) non-autistic child.
Our baby is now 14 months old and he is wayyy more advanced socially than my 3 1/2 year-old. My baby has only a handful of words, whereas my older one has a vocabulary of several thousand words. But even with few words, my baby can communicate so much better! It's phenomenal! There's the plaintive wail of fatigue, the whiny hunger cry, the brief staccato cry that indicates a soiled diaper, and, best of all, the pathetic escalating wails when he's injured (you know the ones where they go WAAAAAHHHH, then silence as they draw in their breath for what seems like forever, only to shift into second gear WAAAAAAAAHHHHHHH followed by an even longer inspiratory pause and an easr-splitting WWWWWAAAAAAAAHHHHHHHHHHHHHHHH!)
Interesting, my older son never had that highly expressive, escalating cry. It's as if he lacked the language pragmatic skills to be able to communicate that degree of pathos.
OK I've really gotten off on a tangent here. I am truly thankful that my younger son appears to not be on the autistic spectrum. Of course, things could change and he could always regress, but his development so far is reassuring.
At the same time, it angers me even more that my older son has this huge challenge to face. I realize now why I never felt comfortable putting him in daycare- even as a baby, he lacked the ability to bond with caregivers or communicate his needs. OTOH I know I could leave my younger son in any reputable child care setting, because I just *know* he'd be alright. He'd miss me, but he'd love being around the other kids and he'd communicate his needs to his caregivers, easily. But my older son, I still don't feel comfortable leaving with anyone else, not even my mom. The few times I have, something has always happened, primarily due to his inability to communicate appropriately.
So that's why I am and will continue to be SAHM, MD for as long as I have to. And given the experiences I've had so far with the school district, I will probably end up having to home-school him. Which means I may not be able to do residency for up to 15 years. And as for student loans, well...we'll cross that bridge when we get there. Hopefully I'll be able to at least work part-time in a couple of years, maybe teaching anatomy and physiology at a CC, and at least earn enough to make my loan payments.
My only hope- and the one thing that keeps me going- is RDI. The more I learn about it, the more I like it. I've been reading as much as I can and trying to implement it into our lifestyle as much as possible. RDI is not a quick fix, so we have to be patient, but we've noticed some improvements already. And I've found a supportive group of parents on the web who are doing RDI with their spectrum kids, so that keeps me going as well.

Sigh...I'm bummed-out today. It all started yesterday, when I happened across an old alumni newsletter from high school, which I dropped out of after 10th grade (long story...) All of my classmates seem to have become highly successful physicians, attorneys, business executives, research scientists, etc. And what am I? Stay-at-home mom and, in most people's eyes, not a very good one at that.
Normally I don't waste much time thinking about what other people think of me, mainly because I'm way too busy dealing with my son's autism, but for some reason it's getting to me right now. I guess the other thing that prompted this was a recent visit to my SIL's, where she kept subtly criticizing aspects of my parenting style, implying they were responsible for my child's autism. Her kids are about my kids' age and are perfect, ergo she must be a better mom. I spend every minute of my life trying to help my son and yet he's still autistic. But a lot of people just don't get that he's NOT a bad kid and we are NOT bad parents and he can't help the way he acts. People think he's being rude because he won't say "hi" to them or smile at them or give them hugs and they just don't get that he has a friggin' DISABILITY that makes him this way. So then they basically ignore him, which is exactly what they SHOULDN'T do. Even his own grandmother.
My husband and I spend literally every minute of our lives with the kids. We have to, just to keep our older one in this world. We'll continue to do it for as long as we have to because we have seen what a huge difference it makes, especially since we can't afford to pay for outside therapists to work with him. So about the only break I ever allow myself is getting on the computer for an hour or so after the kids are in bed, and sometimes watching a movie on TV. When DH is home from work, he allows himself a half-hour to work out and the rest of the time he's working with our son. That's it. We have zero time for one another and I know that's not healthy, but there's no alternative. There's no one who could watch our son, so there's no way we could go out and have a relaxing evening together knowing that. And that's ok- we had many wonderful years together prior to the birth of our son and for those I am truly thankful. And hopefully we'll have more of those days someday in the future, if we can help our son to function independently in this world. I guess what really burns me up is that anyone would dare criticize us as parents when they have NO IDEA how much effort we have put into getting our son to be as good as he is now! It's a 24/7 job with no vacations and we have never complained- quite the opposite, we are glad that we are doing this for him. I just can't stand the gall of someone to criticize us when they have no idea what we're going through. This goes for my mom as well. I tried SO hard to explain his condition to her, to explain RDI, and I had really looked forward to her helping us in this journey. Instead, she repeatedly berated me for my faulty parenting and inappropriately criticized my son for behaviors she disapproved of. She bonded with the baby as if he were the greatest thing in the world, but basically discarded my older son as a worthless piece of trash. Why, oh why, can't she see past the disability for the great kid he is? And if even own grandma rejects him, how will he ever survive in this world? He literally has no one except mom, dad, and little brother (who loves him to death, fortunately!) Every day, I fear what might happen if something were to happen to my husband or me. I know our baby would be ok, as he would grieve, but eventually bond with his new caregiver, but my older one is so complex, I doubt there is anyone in this world willing to put in the kind of effort required to get close to him. It would absolutely destroy him. I try not to think about that too much, but I can't help it.
I know what we need. People around us to support us. We're much too isolated. Problem is, we're so consumed with our son that we don't have time to meet people- the very people that would be there to support you in times of need. We've thought about joining a church, but it's the same problem: what to do with our older son? We can't just stick him in the preschool class or children's church. My husband has actually scouted out a local church once or twice on his own, but you don't really meet people just by sitting in a sermon. It's really more in all the social gatherings, but there we'd have to deal with our older son, so we would never get a chance to get to know anyone anyway.
There is a local support group for moms of autistic kids, though I've never been able to make it to one of their meetings so far. I'm a little uncomfortable with the strong religious fundamentalist orientation of this group, but it probably goes with the territory, as we live in the heart of the Bible Belt. I'd prefer a group that welcomed all faiths, though I guess it's worth a try.
The one good thing is that my son does seem to be bonding with the student I hired to play with him a couple of hours a week. I can only afford to have her come once or twice a week, but he asks for her by name and looks forward to her coming. How I wish he had an aunt or grandma to do that for free! Unfortunately, she'll be graduating this summer, but I'm not going to think about that right now.
Back to my high school...I guess I had these dreams of showing up at my 20-year-old reunion and saying "Remember me? The high school dropout? Well, I did ok, too. I'm a happily married, successful physician and mom to 2 beautiful boys."
Instead, I have a special needs child, an insane amount of debt, and a worthless piece of paper that says I'm an MD.
OK, but to look on the bright side, 1) I do love my husband 2) my younger son seems perfect so far 3) my older one is on the mild end of the autism spectrum and 4) they can't take my MD away from me, either.
OK, if anyone has read this far, I apologize for this post. I am not normally one to wallow in self-pity and I know we all have our crosses to bear. I've actually thought about just deleting this post and keeping it to myself, but since it expresses my feelings at this time, I'll go ahead and post it.

I've come to the realization that I will definitely not be doing residency anytime in the near future. Probably not for at least 15 years or so. My son needs me full-time for as long as possible and, in all likelihood, he will have to be homeschooled for his own benefit. I never expected to be in this position when I started medical school, but life has a way of throwing curveballs and I will do what I think is best for my son. Given the experiences I've had so far with public schools, as well as my son's behavior at playgroups, Kindermusik, and other community events, there is no doubt in my mind that his development is best facilitated by having a one-on-one teacher fully committed to his well-being. No one is as committed to his development as I am, so that means I will have to be that teacher by default. Fortunately, homeschooling has become an increasingly popular choice in this area and there are lots of homeschoolers' groups that offer support for parents, opportunities for socialization, extracurricular activities, etc.

I've already emailed one of my favorite attendings at my alma mater, who is also program director, to ask if it would ever be possible for me to start a residency 15 years after med school graduation. His reply was interesting: he said that generally, his program weeds out most applicants who are more than 3 years removed from graduation. However, they do make exceptions and every year, they do interview some candidates who have been out for awhile, some 10 years or more. That said, he added that, for me personally, if he were still program director, he would let me in regardless of how long it had been. He said I'd have a pretty steep learning curve for the first month or two, but that he had no doubt I'd be able to catch up quickly. So that's reassuring, though of course who knows if he'll still be PD then? Surely, somebody, somewhere would give me a chance, especially in primary care!

I found it interesting that apparently there are a sizable number of candidates 10+ years out of residency! Who are these people and what have they been doing after medical school?

The other option I've considered is a path residency, perhaps in the next few years. But I'm realizing that even though path is much more family-friendly than IM or FP, a residency is still a full-time commitment. It's still 40-55 hours per week, plus lots of study time at home. So for someone who is actively focused on providing one-on-one therapy to an autistic spectrum child, it's still too much of a commitment. And since I have a one-time opportunity to make a difference in my child's life while he is still young, that's what I have to do.

So that pretty much settles it: if at all possible, I will not be working full-time until my older son is a teenager and maybe longer than that. Hopefully, by then he'll be independent enough for me to go back to residency then. Whether I end up back in primary care or switch to path remains to be seen, but right now it's a moot point.

Now, that brings me to my greatest fear: if God forbid, something were to happen to me. My son has only me, my husband, and his baby brother in this world. Only my husband and I care enough about him to do everything we can to help remediate his autism. We're the only people he bonds with, the only people he really can communicate with (and even we have significant communication barriers at times, but hopefully that will improve as he gets older.) But I can't dwell on that fear right now. I've got to focus on the task at hand, which is implementing RDI to help facilitate his social-emotional development.

My other focus is finding a part-time job. I've been in touch with the local community college and am applying for an adjunct faculty position teaching anatomy and physiology at night. I think I'd like to start with one class per semester and eventually work up to 2 courses per semester, which should be just enough to make my student loan payments. Hopefully the timing will work out with my husband's schedule, so that he can be home when I'm at work and vice versa. We have no back-up child care, so that makes things a little tough, but we'll just have to see how things go.

Later this week, I'm planning to attend a meeting of that autism support group I mentioned earlier. Even though the group appears to have a strong religious slant, I think it's worth a try- maybe I'll meet somebody there that I can connect with or at least get some helpful information. God knows I need some support. I have none, other than my husband, and that relationship is rocky right now. We're both overly stressed and have zero time for one another. It would be nice to at least meet someone else who knows what we're going through.

Isn't it interesting that I never give a second thought to my younger son? I don't think I'll end up homeschooling him because I can already tell that he would LOVE school. Even at 15 months, he makes friends wherever he goes. And he can stand up for himself in any situation already! Not to mention- I think I would go berserk having him home all the time. So this is what it's like to have a typically developing child. WOW! It seems so easy compared to what I went through with my older one.

Thank God the baby is normal so far. I know he's not out of the woods yet, as regression is always a possibility, but by this age my older son already had a diagnosis, so things are definitely looking good by comparison. Now, he's still a fussy baby and a terrible sleeper and he's becoming a whiny, demanding toddler, but that is all perfectly fine with me as long as he's otherwise normal. As long as he smiles at people and plays peek-a-boo with everybody and cries when I leave him but is instantly reassured when I return. As long as he watches other kids and points out things that interest him and just gives me that big beautiful smile that says "I love you Mommy, you're so wonderful, you're the greatest thing in the world!" It just melts my heart away and it's something I never experienced with my older son. Hopefully someday!

Wow! Three months since my last post. Where has the time gone? I'm not even sure where to begin at this point. Let's see...

My older son turned 4 a few weeks ago and we had his first "real" birthday party, inviting a few cousins and kids from his gym class. It went well and he had a great time. Incidentally, I'm sooo happy he finally likes birthday cake- for years, he refused to even try it, which made me sad because I think he was missing out on one of the great joys of childhood!

I also FINALLY got him potty-trained a few weeks after his 4th birthday, thank GOD! He still demands a diaper at night, but seldom wets it- I give in at night, but no diapers during the day and he almost never has accidents, maybe once a week tops. HURRAY!! Now I will never again have to listen to other people lecture me on what a bad mom I am for having a 4-year-old still in diapers!!!

Now, the bad news is that since he's been potty-trained, his behavior has regressed. He's become really resistant to doing RDI activities with me and he has frequent crying spells and lots of perseverative, repetitive language. I'm hoping this is just a phase, a response to the stress of potty training, and that it will pass. But I've contacted a couple of child psychs in town and gotten on their waiting lists, so hopefully I can get some more insight into what's going on with him and maybe some advice on how to handle it.

My 18-month old is doing fine- walking, talking, pointing, smiling, everything he's supposed to be doing. He worships his older brother, which sometimes annoys him, but usually he's really affectionate with him and gives him hugs, etc. Only problem with the baby is that he has a very demanding personality and cries any time he doesn't get his way- which invariably makes my older son cry as well and then he is very difficult to console. So life is a challenge for me- keep the baby happy so he doesn't cry and make the 4-year-old cry, which makes the baby cry even harder, etc. etc. Some days are really, really tough, especially since I have no support.

I did attend a couple of meetings of the autism support group and that did help. What helped more than anything was seeing how severely affected some of the other kids are. It's heart-breaking. So whenever I get down on myself, I tell myself to thank God that my child has a normal IQ, doesn't have severe sensory problems, doesn't have major behavioral problems. It really hit home when I invited one of the other moms to bring the kids to a local indoor playground. She asked "Do they have bright lights? Do they have loud noises? Are there any visible electric outlets?" Her son is very sensitive to bright lights and loud noises and is utterly obsessed with electric outlets- so this wasn't an option for her. My son is fine with lights and noises and his biggest obsession is trains, which is inappropriate in intensity, but at least it's a typical interest for a 4-year-old boy, though certainly not to that extent. I don't even think twice about taking my son anywhere and I cannot even begin to imagine what life must be like for this other mom. Bottom line: there is always someone else worse off, no matter how bad you think you have it. I try to always remember the saying about the man who wept because he had no shoes until he met the man with no feet.

My DH is still working at the same job- not perfect, but ok so far. We're not getting along very well, unfortunately, mainly because I am so stressed out from dealing with the kids. Hopefully things will improve once my older son gets over this difficult phase he's in.

But I am starting to change my mind re: homeschooling. I'm not sure my nerves can handle being home with both kids all day, every day, for years and years. I think I'm going to try to get him in a typical public school with a one-on-one aide. There's really no reason he shouldn't be in a regular class, since he's quite intelligent and has no major behavioral issues. His communication and social skills are, of course, impaired to the point where he would need an aide. I'm not thrilled with the public schools here, but private school isn't an option because of his disability, By law, public schools are required to provide a free, appropriate education for kids with disabilities, including one-on-one aides or whatever accommodations are necessary to help them function. Private schools have no such obligation. I think that the school where I've been taking him for speech and occupational therapy is probably one of the better ones in this area, so I think we'll try to plan on sending him there. Ideally, he could go to public school at least for a few years, then I may pull him out and homeschool beginning in middle school (when the kids get meaner and life gets really difficult for kids on the spectrum) By then, my younger one will be in school as well, so I think I could handle having one child to homeschool.

As for work, who knows? I think I should probably plan on a part-time career as adjunct faculty for the near future. Hopefully I can at least earn enough to make my loan payments. Who knows when I'll be able to do residency? I do need to try to make myself study for Step 3, though, so I can get all 3 steps taken within the requisite 7-year period.

Somebody needs to knock some sense into me about having a 3rd child. My second son is such a joy, it really makes me want another. Sure, he can be a bratty, demanding toddler at times, but he's such a sweet, precious beautiful little boy- I just can't help but think about having another. I always envisioned myself with 3 kids and I'm having trouble letting go of that idea. But, realistically, it is all I can do right now to handle 2 high-needs kids. If I were to add a new baby to the mix, my older son would suffer tremendously. So that's that. Plus, my advanced maternal age and history of pregnancy-related complications put me at higher risk. And there's always the chance the baby could have autism. So I need to just thank my lucky stars that my second son is neurotypical (so far, anyway) and focus all my energies on helping my older son as much as possible.

Wow! Where have I been? It has been a year to the day since I last posted in this thread. I still read MomMD almost daily, but never got around to updating this blog...I'm going to give it another try, if anyone is still out there reading this ;-)

My older son is now 5 and his baby brother is now 2 1/2. I'm still mostly at home with the boys, which I still LOVE! I guess I truly am cut out to be a SAHM because I've been at it for 2 years and have zero desire to go back to work full-time. If money were not an issue, I could totally see myself doing this until my kids are grown. It's been especially worth it to see the improvements in my older son. He has made huge strides in the last 2 years and I know those are in large part due to the one-on-one work I've done with him.

Unfortunately, money IS an issue and I have just one year remaining on my economic hardship deferment for my student loans. So that's why I recently started teaching anatomy and physiology part-time as an adjunct instructor at a community college. The pay is horrible (around $1300 per semester per course!) but I've enjoyed it so far. I figured out that if I teach one class per semester, I can earn just enough money to pay the interest on my student loans (around $4K per year). My lender offers the option of making interest-only payments for the first 10 years, so if I can just earn that $4000 per year, I can get by for the immediate future. That's probably the route I'm going to take.

The students in my class are mostly pre-nursing and other allied health fields, are mostly older, working adults, married with children. For the most part, they're highly motivated to learn and to improve themselves career-wise, so that helps make my job easier. Of course, anatomy and physiology isn't always the most exciting subject in the world, but I do my best to make it clinically relevant and they do seem to appreciate that. Of course, every semester I get one or two bratty little kids who try to get away with skipping class, not doing the work, then begging for special treatment, etc., but fortunately, those are the exception rather than the rule.

I don't know if I will ever be able to work more than part-time, but I seriously think I could see myself teaching on a long-term basis. Of course, the pay would be a small fraction of what I could earn as a physician in practice, but at least I wouldn't need to go through 3 years of residency, which I know my family wouldn't survive right now or anytime in the near future. I'm not sure what permanent full-time faculty get paid, but I'm thinking if it's at least $50K or so, then that would be enough to get by and repay student loans (albeit quite slowly!) Anyway, something to think about...I'm definitely glad that I took this part-time position, just to test the waters and see if this is something that I think I'd want to do. So far, it's gone better than I thought it would.

It's amazing...I STILL don't miss medicine! For someone who couldn't imagine herself doing anything else in life besides medicine...who re-applied 3 times before I finally got in...how is this possible? Well, it's quite simple, really. It's my children, particularly my older son. Every time I think about being on call or having to stay late to see a patient, I think of my son. I think of all the times in medical school that I had to sneak home on rotation whenever he was having an especially difficult day and driving my husband crazy. Even though he's much better now, we still have our issues and I know our whole family would suffer tremendously from my absence. So that's that. I can't ever do anything where I have to put the needs of my family behind that of my job. Period.

Of course, the economic reality is daunting- we don't own a home, have virtually no retirement savings, no college fund for the kids- and I have huge amounts of debt with no long-term prospects for paying it off. But I will just have to take things one day at a time. The college fund- well, I didn't have one either, and I somehow managed to earn an MD degree. I'd like to have provided better for my kids, but maybe they'll qualify for financial aid and it won't kill them to work a part-time job or take out a few loans in college(though hopefully not 6 figures like I have!) More importantly, college wouldn't even be in the cards for my older son if I were not constantly working with him on remediating his autism.

Retirement savings- well, this one is definitely a concern. I'm going to try really hard to pinch pennies and get my husband to stash some money in a 401 (k) at work. As for myself, well- hopefully in the future, as my children get older, I'll be able to teach more classes and start saving.

Owning a home- we currently rent and pay more than most people in this area pay for a mortgage. We don't have enough money for a down payment and my DH doesn't earn enough to qualify for a mortgage over $100K or so- which would basically buy you a dump in a dangerous neighborhood around here. We currently rent a house in an acceptable neighborhood that was last sold for around $180K or so, so our goal would eventually be to buy something in that range. I know if I were a resident, banks would be beating down the doors to offer me 102% financing including closing costs- despite my debt. But currently, that's not an option. So...we keep renting in the meantime.

But this will all be worth it someday, if we can continue to help our son. He's made very significant progress with RDI- enough that I'm going to try sending him to kindergarten this fall. We're going to start with half-days and he is supposed to get a one-on-one aide in a regular kindergarten class. I'm nervous about it, but I think it is worth a try, especially since he says that he WANTS to go to school. It's a decent public school, with a strong history of inclusion of students on the autism spectrum. I've met both the principal and his kindergarten teacher and they both seem very supportive, so we'll see how it goes. If it doesn't go well, I can always pull him out and homeschool. And as he gets older, I can see that it might not work anymore, especially as he approaches middle school. But, again, let's not get ahead of ourselves here...one thing at a time!

My 2 1/2 year old is very high needs, but seems normal otherwise, so I think we are almost out of the woods here. If he were to develop autism now, it would be a highly unusual presentation. Thank God! My heart goes out to all the families I know with 2 kids on the spectrum. I can't even begin to imagine what they must have to go through.

Well, this has been a VERY long post...hope I haven't bored everyone to tears!

Thanks so much for the PM's! I enjoy reading them and it means a lot to me that someone would take the time to read all my rants and random musings. I guess I have been feeling rather isolated lately and maybe that's what prompted me to revive this thread- leave it to you guys to make me realize I'm not alone!

Someone brought up the "mom" issue- I have somewhat good news to report on that front. Over time, my mom has gotten much, much less critical of me. Of course, she still has her issues and I can't change them, but she has slowly begun to realize that perhaps I do have a clue what I'm doing with my children. It's hard to deny the tremendous progress my older child has made over the past 2 years- he used to be utterly morose, sullen, withdrawn, with frequent crying spells 2 or 3 times a day, often for no apparent reason. Now, he's mostly a happy kid, much more outgoing, and the crying spells have diminished to maybe once a week or less. She now admits that I must have been doing something right with him. Unfortunately, though, she still doesn't really know how to interact with my son. He is DYING to have a relationship with her- he constantly begs to play with her when she visits- but she invariably gives up after about 5 minutes and ends up playing with the baby instead. I wish she would make more of an effort to play with him, but I've learned to live with it- I just let my mom take the baby so I can devote my full attention to my older son.

That's a problem he's going to have often in life. He's made such huge strides, but it's becoming painfully obvious that he's still got a long way to go. For example, he has developed an interest in other children over the last several months or so. I never dreamed this could happen and I literally jumped for joy once I realized it wasn't a fluke. However, he lacks the social graces of a typical 5-year-old. When he sees a kid he wants to play with, he will state "You want to hug that baby" or "You want to play with that one." (He still has pronoun reversal, referring to himself as "you" and the speaker as "I". Theory of mind, anyone?) He will try really hard to get the kid to play with him, following the kid around, but usually the kids ignore him. Increasingly, they have started making fun of him or occasionally becoming aggressive. My son has no conception of aggression and he doesn't even know that the kids are making fun of him, so he usually keeps trying to play along until I lead him away if things start to get ugly.

He seems to have better luck with younger kids- 2 and 3-year-olds, who are more on his social developmental level anyway. On a couple of occasions, he has had successful play episodes with kids this age and I have just sat back and watched, with this big huge Cheshire cat grin on my face, perhaps unfathomable to anyone who hasn't dealt with an autistic spectrum child. I never dreamed my child would ever show an interest in other children. Yes, he has a long way to go, but there is hope.

That's also part of the reason he will only be attending kindergarten part-time. I want to provide him opportunities to go to Kindermusik and other activities with younger kids so he can hopefully have more opportunities for successful playdates. Right now, it's sort of hit or miss- he may meet a kid to play with at a playground, but chances are, we'll never see the kid again afterwards. It would be nice if we had the same kids to play with over time. Unfortunately, I still don't really know a lot of other kids- I lost touch with the one mom I knew last year once her son started pre-school and besides, she lived on the other side of town anyway. The kids in our neighborhood here are much older than him (and a few have made fun of him as well, unfortunately.) I've met moms at Kindermusik and other places and have tried inviting them places, but it's never worked out. I invited his whole Kindermusik class to his birthday party, but none of them came, so either these moms aren't looking for new friends or maybe they don't like us or maybe they were just busy that day, who knows? In any event, I need to look harder for opportunities for him to meet other kids, now that he's finally showing an interest.

Oh- his train obsession has dwindled to what I would consider an appropriate level for a 5-year-old. I never thought this would happen, either! He likes trains, but he likes lots of other stuff, too. He has recently developed an interest in stuffed animals, which seems inconceivable. I remember trying to get him to hug a teddy bear way back when he was just a baby and he never showed the slightest bit of interest in anything soft or cuddly. Now, all on his own, he will play "Hug Mountain" with his stuffed animals, where he and I and all the animals are supposed to hug each other. He tells stories about what each of the animals like to do and where they've been...it's unreal!

He's also really, really smart. I taught him to read because he was interested and he now reads quite fluently on about a 2nd grade level. I also started some simple math lessons with him and he already knows all his addition facts to ten and then some- and this was without hardly trying! We try to do a couple of fun science experiments a week, e.g., dissolving sugar cubes or salt in water, then letting the water evaporate and the solid re-crystallize. Or building a vinegar-and-baking-soda powered rocket. Or just mixing up food coloring to see what colors he can make, etc. It's all lots of fun! Of course, he's way beyond kindergarten-level academics- I didn't plan it that way, it just sort of happened. So I'm going to try to have him go to school primarily for the non-academic portions of the day- circle time, center time, art, music, PE- hopefully where the stress level is lower and the opportunities for interaction higher. The rest of the day, he'll be home with me working on RDI or at Kindermusik or hopefully playdates with younger kids.

I could go on and on. I think he's the best kid in the world. The way he takes care of his younger brother is so sweet. For example, if we're at the playground and the 2-year-old starts to climb a dangerous ladder, my 5-year-old will call me over to help him- or sometimes go help him himself if I'm too far away. If his little brother leans over a fence too far, he will put his arm out to protect him. He grabs his hand when we cross the street without my even having to ask. He is constantly hyper-vigilant, always attending to his little brother to make sure he's ok. I never thought this child could be capable of this degree of concern for others!

OK, this post is long enough already...but just wanted to share because progress like this is what keeps me going! Yes, we still have a long way to go, but if it's possible for him to care for his little brother and want to play with other kids and learn academics, then it is possible for him to do almost anything. It won't be easy, but I now have hope that maybe, someday, he can be an independently functioning adult who will have friends, hold down a job, maybe even get married and have a family, who knows?

I ran into a student of mine today at the local kids' museum. Yesterday she knew me only as her physiology professor, "Dr. D, MD", as I delivered a lecture on GI physiology. Today, she saw me dressed in shorts and T-shirt, pushing my 2-year-old around in a stroller and running after my 5-year-old. We chatted about our kids, just like I do with other moms I meet- but it was interesting because she had never seen me in my SAHM role.

And it was interesting for me- because it made me realize that my part-time teaching job seems to serve a need that I previously didn't realize existed. The need to be appreciated, to be respected, to experience success. My instructor evaluations are among the highest in our department, so that certainly makes me feel good. Several students have said that they wish I were in practice so I could be their doctor. I've heard students tell their friends that they need to be sure to get me as their instructor ("She's awesome!!") (Of course, I'm sure there will always be students who don't like me, but man, it sure feels good to hear from those who do!) I guess I must have really needed this boost to my self-esteem!

More importantly, I'm realizing that I'm able to be a mentor to future generations. I recall way back when I was a freshman (at this very same community college, no less!) and how much I benefited from having professors as mentors. In fact, I probably would have dropped out of school altogether if it had not been for the encouragement and support of one professor in particular. Eighteen years later, I still recall how it meant the world to me when she wrote on my chemistry quiz "OUTSTANDING!! The work of a REAL chemist!" So when someone does well on a test or shows significant improvement, I try to take the extra few seconds to at least write "Outstanding!" or "Great job!" on their paper. Insignif as it may seem, it often means a lot to the person on the receiving end.

In the past couple of years, I've often felt like a failure because I'm not practicing medicine. People always ask me why I'm not in practice and most people think I'm utterly insane for choosing to be a full-time SAHM. But now, I have students who look at me and see me primarily as Dr. D., MD. They know that I'm also a mom and that I'm choosing to stay home to help my disabled child. They also know that I got my start at this same community college. Maybe some still think I'm crazy for not practicing medicine, but all of them respect me as an instructor. Hopefully, I might be able to help motivate someone in the class to pursue their dreams- be it nursing or respiratory therapy or pharmacy or whatever. (No pre-meds that I know of, but that's probably a good thing in my case!)

As I get more comfortable with teaching, I'm starting to get really into it. More importantly, I can teach the way I want to...which means I try to add in lots of clinical correlations, anecdotes from my med school years, case histories...and try to eliminate as much of the rote, meaningless memorization as possible. For example, next week I'm supposed to cover metabolism. Their textbook is full of all the steps of glycolysis, Krebs cycle, electron transport- all this crap we had to memorize in med school and for Step 1 and never (I mean NEVER!) used again. I'm not going to require that. No patient is ever going to die because a physician (or nurse) doesn't remember the name of every intermediate in the Krebs cycle. In my class, we're going to focus on the big picture as much as possible. I'll mention the terms glycolysis, Krebs cycle, and electron transport, but the focus will be on developing a conceptual understanding of the big picture. We'll focus on what's clinically relevant, e.g., why blood ketones are elevated in the Atkins diet and how that relates to fat catabolism, what happens to glucose and insulin in diabetes, etc. (Honestly, I've never understood the value of memorizing structures and intermediates. I personally think biochemistry is one of the most fascinating subjects in the world- but NOT the way they teach it in medical school!)

On an unrelated note, we've recently made some improvements on the home front. My DH and I have barely seen each other for the last several years. We are basically both full-time caregivers who happen to share a house. We have no babysitter, no one to watch the kids. He goes to bed early, the kids stay up late. I put them to bed, then spend an hour or so on the computer, then go to bed myself. My 2-year-old still insists on sleeping with me, so DH has been relegated to a twin bed in the guest room. He gets up early in the AM to work out and go to work, is gone all day while I'm home with the kids. Then, I go to teach in the PM and he takes the kids. Basically, we never see each other. And on weekends, one of us is almost always interacting one-on-one with our older son while the other has the 2-year-old. And so it goes. We have this idea that one of us always has to be interacting with our 5-year-old at all times, so we have completely sacrificed ourselves and our marriage in the process. And it was killing us.

So we've recently started doing the unthinkable and using TV as a babysitter. Both kids still love Baby Einstein videos and that's about the only thing my older son will watch. We've always hesitated to let him watch them because he's really way too old for them and it's basically just stimming for him, but we have decided it's not going to kill him for 30 minutes a day. And we get a blissful, much-needed, uninterrupted 30 minutes alone together. :goodvibes: I feel like I finally have my husband back. Thank you, Julie Clark and everybody at the Baby Einstein Company!

I ran into a guy from my med school class today. He's now a 3rd year resident, married and a father of 2, looking forward to finishing up and going into practice. That's the first time I've seen anyone since graduation and I've often wondered how it would feel.

Well, honestly, I feel pretty bummed. I didn't know this guy well, but he seemed like a really nice guy. But for some reason, seeing him brought back a whole lot of emotions for me. It sounds ridiculous, but for whatever reason, I have this on my mind, so I'm going to try to figure out what's bothering me.

Let's rewind to med school graduation, a little over 2 years ago. I had a moderately autistic 3-year-old, a new baby, a terminally ill mother-in-law, and a very unhappy, unemployed husband who had been a SAHD for 2 years. All that notwithstanding, I was attending my med school graduation right along with the others in my class. I was proud of myself and so was my husband.

But it wasn't much of a celebration. Honestly, it felt like a slap in the face. It seemed like everyone in the class was being honored with some award or another- some worth several thousand dollars! Everyone except me, that is. I wasn't expecting an award myself, of course, but it got really old after awhile. After over an hour of listening to the laundry list of awards that my esteemed colleagues were receiving, I tuned out and started chatting with my neighbor (a really nice guy whose name never got called during the awards ceremony either). He felt somewhat slighted himself, so it felt better to have someone to commiserate with. Awards were given for the best overall student, the best woman student, the best women's health student, the most humanistic student, the best academic student, and hundreds more, blah-blah-blah. There was even an award given to someone who had overcome the most significant adversity, which was given to a woman who had gotten divorced during medical school.

I'm happy for all the people who got awards, but I wonder if the administration ever stopped to think how that made the rest of us mere mortals feel? We'd all worked just as hard- some of us even harder, against even more difficult odds- and it just seemed like a slap in the face for the same people to be honored over and over and over again, while the rest of us were completely ignored. Why can't they just honor the valedictorian and salutatorian, then leave it at that?

I then heard the announcer mention something about autism. Something about how one student had done a remarkable job with a research project on autism and, as a result, the student's mentor had inaugurated a new award and this student was to be the first recipient. Dear God, I allowed myself to think, does someone want to honor ME?! I had spent the better part of my 4th year doing research electives related to autism: a couple of months in a child psych elective studying autism treatment, a month on a neuroanatomy elective reviewing the literature on neuroanatomical and neurophysiological abnormalities in autism. I had been an invited speaker on autism at various resident conferences and grand rounds at my medical school. I was even invited to serve on a state committee for the treatment of autism. I had given presentations on autism during my peds, psych, and family medicine rotations. Now, the reason I did all that was pure self-interest. I wanted to help my son any way I could. I wanted to learn as much about his condition as humanly possible. I wanted to meet as many people involved with autism as I possibly could. As I said, sheer self-interest. I never expected to receive any other rewards for those efforts.

Well, I didn't. The inaugural award went to yet another one of my esteemed colleagues for writing a "truly outstanding" paper on autism. He had written it while on rotation with the same developmental pediatrician who had diagnosed my son. That award recipient was the guy I ran into again today, who's looking forward to graduating from residency and entering practice, the guy who has a wife and two perfect little kids.

I'm thrilled that he wrote a great paper on autism. I truly am. Especially since he's planning a career in peds. Back when my son was diagnosed, too many pediatricians were way too quick to dismiss my concerns and if I had listened to them, I would never have sought help for my child and who knows where we might be then?? So I hope that all the pediatricians in training become as well-versed in autism as this young man seemed to be.

At the same time, I couldn't help but be struck by the irony that this guy was receiving an award for writing a paper on autism when I was living it. Every day. Every night. All day. All night. Never-ending. All-encompassing. Living hell. This was back in the bad old days, when my son was basically stuck in almost non-stop tantrums. When he was basically completely oblivious to my existence. When he woke up screaming every night and was impossible to console and would tantrum for hours on end for no apparent reason. And still I got up and rounded on my surgery patients the next morning at 4 AM. When on call, I still worked my 30-hour shifts like everybody else, then came home, rested for an hour or two, then awoke to relieve my husband and provide one-on-one therapy to my son. I managed to squeak through medical school with minimal studying and still honor most of my rotations (though NOT surgery!) And despite all that, there I was at graduation, right along with everybody else. And no one- other than my husband-seemed to give a dam*.

OK to say I felt bitter at the time would be an understatement. It would have been really nice to have SOMEONE (besides my husband) validate my achievement, in some small way.

Since then, I moved on- both literally and figuratively- and mostly suppressed memories of graduation for that reason. In looking back at my post I made here 2 years ago, I just briefly glossed over graduation, though I did describe it as "anti-climatic".

Somehow, coming face-to-face with the guy who got this award- the AUTISM award!- has brought all those feelings back to the surface again. I don't like to feel this way. It's not animosity towards this guy- he seems like a really nice guy who'll be a great pediatrician. Maybe it's jealousy? Because his kids are perfect and mine aren't? Because his parents are in town to help out and mine aren't? Because he's going to be making real money this time next year and I'm not? All of the above? I thought I was way past all that, but maybe I'm not being honest with myself.

Ahh, how I hate painting myself in a negative light on a public forum! Once or twice, people have called me a "saint" for what I'm doing for my son...but now the truth emerges...I'm anything but!! Yes, I'm jealous. Yes, I've been bitter, though not as much anymore. Today, I'm mostly thankful that my son is doing soooo well.

As if to remind me, a few minutes after I saw my former med school colleague, I pushed my 2-year-old's stroller past a little boy in a wheelchair. A little boy who appeared to have moderate-to-severe cerebral palsy or some other form of traumatic brain injury. A little boy who will likely never walk. Maybe never talk. Maybe wear diapers all his life or require catheterization. A little boy whose parents face obstacles that I'm sure I can't even begin to imagine. I looked down at my perfect, beautiful little 2-year-old and wanted to cry. Because he's so perfect. And because this other child was not. And then I felt guilty that I was feeling better at the other child's expense. Why should it require seeing someone who is worse off to make me appreciate what I have? Why should I have to compare myself to someone else to be thankful for what I've got? I've mentioned that saying before: "I wept because I had no shoes until I met a man who had no feet." Well, why should it take meeting a man with no feet to make someone feel better? Are we all in competition here to try to find someone worse off than us? Is this just human nature? There's a saying "There's always someone who's worse off than you are". What about the one person in the world whose life IS the worst-off worst-possible-case scenario? Are the rest of us supposed to be HAPPY about this? Relieved it's not us?

Well, it's getting late, I'm starting to rant, and I'm obviously not going to come up with any answers tonight. Bottom line- my older son is NOTHING like he was 3 years ago and for that, I am eternally grateful. He's a fabulous kid, very mild-mannered, very easy-going. It's nearly impossible to believe he's the same kid who made all our lives so miserable just a few short years ago. Still, there are thousands of families whose lives ARE still a living hell due to autism (or untold other conditions.) I wish there were something I could do to help.

I think I'm finally getting over the overwhelming urge to try for baby #3. For the past year or so, not a single day has gone by that I haven't utterly obsessed over having a third child. I've discussed it on here a couple of times. I have thought about it several times a day. I've listed all the pros and cons and, of course, the cons win overwhelmingly. The higher risks of autism due to family history, genetic disorders due to advanced maternal age, pre-term labor, pre-eclampsia, and gestational diabetes in prior pregnancies. The very real risks that I could have another child significantly more disabled than my older son. The financial considerations. The reduced time available to help my older son.
I tried and tried and tried to tell myself this. Then, every time I looked at my perfect younger son, I felt an overwhelming urge to cast aside all rational thinking and try for another baby. Another baby just like him: happy, social, madly in love with me. To make things worse, it seemed like everyone around me was having a third child- some planned, others unplanned. I constantly felt this big huge empty vacuum where a 3rd child should have been.
Add to that the fact that I basically grew up an only child and always wanted my kids to have the big family I never had. Especially if, God forbid, something were to ever happen to one of them.
But the last thing I would ever want to do is burden either of my children with a disabled child. I felt this same guilt when my younger son was born, because at that point, it wasn't at all clear how my older son would turn out. Today, I have hope that, with continuing proper intervention, he'll be ok someday.
Today was the first day in over a year I haven't woken up wishing for another baby. It stems from a talk I had with my aunt yesterday. She had 4 kids, my cousins, who were my best friends growing up. My childhood was quite miserable by most people's standards, but the joy of my childhood was the time I spent with my cousins. I used to spend the night at their house all summer long. We spent our summer days doing all the fun kid stuff that I never got to do otherwise. Growing up, I was always so envious not so much of their material possessions, but mostly of the close relationships they had with each other. They seemed like the perfect family.
As they got older, I saw them less and less and lost touch with them completely for awhile. I know their oldest son had some problems with drugs and alcohol, but he seemed to have gotten through it ok in the end.
Last night, my aunt told me the whole story of the horrors she and her family went through in dealing with Chad. The details aren't important here- they're basically the same as you'll hear with any young man who gets in with the wrong crowd, gets addicted to drugs and/or alcohol, behaves irresponsibly and gets a girl pregnant, etc. "He would have been dead a long time ago", she tells me. Through continued Herculean efforts on her part and at tremendous expense to her and her husband, they managed to get him over it. He's been clean for almost a decade and is now married with kids. He never did get through college, but he does holds down a job. However, he still gets significant financial support from his parents, mostly because of the grandkids.
I asked my aunt "Why? Your other 3 kids were pretty close to perfect. What went wrong with Chad?" She tells me it's partially because her husband was never around. He worked all the time and was a really good provider in terms of money, but he was never there to help her with the kids. He never developed close relationships with them. With 4 kids, there was just no way she could stay on top of what all 4 of them were doing all the time. Fortunately, with the younger children, they learned from their mistakes, he got more involved, and they all got through adolescence without any major calamities.
So, really, it's that simple. Hearing this story- from what I once thought was basically a perfect family- has done for me what no amount of rational thinking has been able to do. The bottom line is there just isn't enough of me to go around. I have 2 children, 1 of whom requires every ounce of attention I am able to give him. Could he make do with less attention from me? Sure! Even now, he would be content to play quietly by himself all day. Would it be in his best interest to do so? NO! At the same time, I can't neglect my younger child, either. And since we don't have much of a family support network, my husband and I are on our own. Right now, we are both at our limits in terms of ability to provide nurturing and sustenance. We're giving them all we've got and I think both kids are getting what they need, though it's come at a huge personal price for us. It's working for us, barely. It wouldn't work if we had a 3rd child. Even if that child were born perfectly normal, like my cousin Chad.
Well, this has been a rather long rant that may be utterly uninteresting to anyone other than myself. But for me, personally, it brings a sense of closure. I will never have the big family of my dreams. But I do have 2 beautiful sons and I will do everything in my power to help both my sons become happy, well-adjusted adults someday. One of the ways I will help them do this is by NOT having a 3rd child so I can devote all my resources to helping them however they need me.
Perhaps a part of me will always wish for that 3rd child, but that's just something I'll have to live with. There are lots of women with fertility issues who would give anything to have even ONE child. To someone struggling with infertility, I'm sure this whole post sounds utterly ridiculous. Gee, I guess we're back to the analogy of the man with no shoes yet AGAIN...OK, I'm going to hit "post" before I end up deleting this entire post!

Aw, shucks, guys Thanks so much for the messages of support. They couldn't have come at a better time. I've been feeling really down today- my son had a huge meltdown that kept me up most of last night and I'm in the midst of a really stressful time preparing my students for their final...so I'm utterly exhausted and depressed to boot.
I'm off to teach my class now, but just wanted to say THANK YOU! You guys truly brighten my day! I'll try to update more later.

Well, we're almost done with summer semester here. My students have their final on Tuesday evening- then I have just a few hours to grade their exams, as final grades are due first thing Wednesday morning, no exceptions! I hate that, especially since my son's school is having a kindergarten round-up that evening and now I can't go!!! I really, really wanted to go to meet his teacher and the other parents and kids in his class. My DH will take the kids, but it's just not the same. I guess I'll just ask him to set up a meeting between me and the teacher later in the week, though it would have been soooo nice if it could have worked out.

No more meltdowns since that memorable Wednesday evening, thank God! I suppose I should be grateful that these meltdowns are increasingly rare- maybe just once or twice a month when they used to occur several times a day. And I am thankful, of course, but for some reason I really let this last one get me down. I guess I just have this illusion that everything's going to be fine, that my son is doing great - which he IS! But then this meltdown happens, inexplicably, for no apparent reason, and it all comes crashing down again. The next day, I pulled up MomMD and saw a couple of new PM's as well as Kris' message and that really brightened my day. Thanks, guys! You really helped me through a difficult time- you can't even imagine how much that meant to me!

Things improved. The other day, we went out to eat at a friend's restaurant and got lots of compliments on how well-behaved my kids were. Yesterday, we went to a birthday party and, again, received lots of compliments on how good the kids were. So...I suppose everything *IS* ok! Just a temporary setback to remind me that my son is, after all, still on the autistic spectrum, even though he does really well most of the time.

Kindergarten starts in a week and I AM A NERVOUS WRECK!! I am SOOOO worried that my son is going to be overwhelmed and his behavior start to regress. So I plan to stay close by, for as long as necessary. I can't go in the classroom with my 2-year-old, but I will plan to sit in the hall outside and quietly read him books while my older son is in class. I want him to know that I am nearby and always available if he has a problem. Hopefully the school won't have a problem with me staying nearby, because this is what I know my son needs right now. Maybe, over time, as he is better able to communicate with his aide and his teachers, I might re-think that strategy, but for now, I am staying put. He will only be attending for 2 hours a day anyway, so it will actually be easier for me to stay in the school for now. And if it doesn't work out...well, homeschool, here we come!

I received an interesting PM that has given me a lot of food for thought over the last couple of days. A woman contemplating med school wrote and posed a number of questions that have really got me thinking. So I'm going to post my response here, because I think it might be interesting to others.

Without divulging too many specifics, here are the questions:
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I am wondering if you would ever recommend medical school to any of your students?

In your situation, is there some comfort in knowing that you do have your MD, which you set out to get, and THEN found that it was not the right path for you, given your circumstances?

Would YOU go to med school again, if given the chance?
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The person who asked me these questions has been struggling for many years with the decision of whether or not to go to medical school. Of course, we each have to come to our own decisions, but I'm going to try to answer these questions for myself as well as I can.

As I've noted before, I too struggled with the decision of whether or not to go to med school. After getting rejected the first time, I took some time off to really reassess what I wanted to do. After meeting so many miserable people in medicine, I tried my best to talk myself out of it. I discovered that I had lots of other interests- foreign languages, travel, computers- and I took the time to pursue all of those. I'm SOOO glad that I did, especially the time DH and I spent travelling while in the Park Service. Yet, despite earning two Master's degrees in other fields, I never felt truly fulfilled in my career. That yearning for medical school never did disappear, no matter what I did. It took me seven years to realize that medical school was, indeed, where I belonged.

As I've noted before, I had to apply a total of three times before I finally got in. And my first two years of medical school were some of the happiest of my life, despite having a difficult pregnancy 1st year and an even more difficult newborn baby during 2nd year. Somehow, I just *knew* that medical school was were I was destined to be. I finally felt at peace with myself and with who I was.

All that changed as 3rd year approached. This was about the time my 1-year-old son was diagnosed with autism. For a while, we strongly considered having me quit to stay home after 2nd year. At that time, I was only $20K in debt and my DH had a great job in a great town with good benefits. The reason I didn't quit: because I just couldn't handle my son's autism. I just couldn't handle the guilt and it was affecting the way I was interacting with my son. My husband, on the other hand, was all gung-ho about staying home and helping our son, so he ended up quitting his job and we all moved for med school. The rest, as they say, is history.

So... what if I had the opportunity to go back and quit after 2nd year, when I was only $20K in debt instead of $155K? Would I do it? Or what if I could turn down my acceptance altogether, knowing then what I know now? Now THAT is a difficult question.

It's tough to say. I think if I'm being really honest with myself, I'd have to say that part of me would be angry or resentful if I had not pursued my MD degree. Even though I'm not practicing medicine in any form, there is a certain level of accomplishment that those 2 initials after your name conveys. I know that sounds superficial, but I guess I'm human, like everyone else, and I do like to be appreciated and I can tell that my students have a lot of respect and appreciation for me.

But if I had known in advance that I would have a child with autism, I would not have pursued medical school. 3rd year, in particular, took a huge toll on our entire family and we all suffered tremendously. Had I not had kids, I think 3rd year would have been loads of fun, even with all the hard work and long hours. But having kids- especially a child with special needs- changed everything.

So, no, I would not have pursued medical school, at least not at this time in my life. Maybe I could have gone back someday when my kids were grown.

However, I'm not saying this would have necessarily been the right decision. It's possible that I would have harbored a lot of anger and resentment towards my son if I felt that I could not go to medical school because of him. Right now, I am CHOOSING to stay home because I WANT to. But if I had been FORCED to stay home- well, that might be a different scenario altogether. It's conceivable I could be utterly miserable as a SAHM who really felt like she should have been in med school. Because the fact is, SAHM's, as a rule, do NOT get much respect. Many people assume that SAHM's are just not intelligent or motivated enough to pursue a meaningful career. In my case, because of my degree, few people think that I'm not intelligent enough. Some people think I'm crazy, of course, for turning down all the money I could be making. But most people who learn all the details behind my decision are very supportive and many are impressed that I would turn down a lucrative, challenging career to be a SAHM to my special needs son (not that I do this to impress people, of course...but it DOES feel good to have your decisions validated by others.)

So...no easy answers. In my heart of hearts, I'm comfortable with whom I am right now. I wish I didn't have all this debt, but I'm still grateful that I had the opportunity to go to medical school. I think it's given me a personal sense of accomplishment that no amount of adversity can take away entirely.

So, my FINAL ANSWERS...

NO, I would not go to medical school if I had it to do over.

YES, there is comfort in knowing that I have my MD and later found out it was not the right path, given my circumstances.

And YES, there are times I would recommend medical school to my students, as long as they went into it with their eyes wide open. I do know some happy people in medicine- in particular, many of the family medicine faculty at my medical school.

As for specific advice for the original poster, I'm not sure if this is helpful, but I guess the bottom line is to research all your options. Look into other areas of health care such as nurse practitioner, PA, pharmacy school. In my case, I often wish I had become a pharmacist instead...but I must confess that a part of me would always want to be a physician, so go figure. It may be that you really are destined to be a physician and really wouldn't be happy doing anything else.

One caveat: if you do plan to have kids, I would try to have them before med school, if at all possible. You never know what kind of mom you're going to be until you actually are one. I never, ever, in a million years could have imagined myself as a SAHM, much less as one enjoying it. It may be that these decisions will fall in place for themselves once you know whether or not you want a family and how you feel as a mom.

Well, this has been a very lengthy reply, but hopefully it may be helpful to someone. Thanks to the original poster for sparking this discussion. I think you have helped me realize that, at least professionally, I'm happy with who I am right now-and that's saying a lot! Who knows what the future holds, but I'm grateful to be who I am today.

OK so I am royally bummed right now regarding the situation with my son's school. Last spring, we had a great IEP meeting in which we all agreed he would attend part-time regular Kindergarten with a one-on-one aide and everyone involved would get trained in using RDI techniques to facilitate remediating his autism.
Now, it turns out that they will not be providing a one-on-one aide, but rather a shared classroom assistant because there are several other special needs kids in the class. The assistant would be a classroom assistant who would look out for my son as well as the other special needs kids in the class. Well, against my better judgment and first-hand experience, I decided to give the shared aide a try. After the first day, my son came home in tears, perseverating on various negative things that had happened to him that day, including the fact that there was no one available to assist him with toileting. So...I tried in vain to talk with both the teacher and the classroom aide, who are both apparently so busy with their other duties that they don't have time to meet with me. I have a meeting scheduled for next week with the principal where I'll certainly do my best to advocate for him, but I'm saddened and frustrated that it's already not working out and no one seems to listen or care. Of course, an IEP is a legal document and they are legally obligated to provide a one-on-one if that's what the IEP says- but I don't see myself actually going to court over this. Besides, that would virtually guarantee bad blood between the school and me and I certainly don't want that for my son (or for his younger brother, if he ends up attending there someday).
Why oh why oh why does dealing with schools and IEPs have to be so maddeningly frustrating?? It is HARD ENOUGH to have a special needs child, much less have to deal with all these issues with the school. I can understand why so many parents choose to homeschool their special needs kids- it's a huge hassle to have to deal with all this. I had really hoped this was going to work. Last year, he attended PE and music classes at this same school with his therapists as his one-on-one aides and it went really well. He enjoyed it and I was able to touch base with his therapists on a daily basis to see how he was doing. Whenever something started to go wrong, we were able to quickly pinpoint and remediate the problem because we were in constant communication with one another. Now, he's dumped in a class with 18 kids, several with special needs, without a one-on-one and a teacher who doesn't even know him and doesn't have the time to get to know him. None of the teachers or aides have RDI training nor do they have time to pursue it. Obviously, this isn't going to work.
I am so saddened because my son was soooo looking forward to kindergarten! All summer long, we've been really building it up, reading books about starting school, buying school supplies together, talking about all the wonderful times he's going to have. Of course, it never occurred to me that he wouldn't be receiving the one-on-one aide that we had agreed upon. I guess I could just homeschool if all else fails, but since he WANTS to go to kindergarten, I really, really, really want to make this possible for him. I've even thought about volunteering to be his one-on-one myself, if only I had someone to watch his younger brother.
Oh well, guess I'll just have to wait and see what happens next week. Meanwhile, I am so stressed out I can't relax or anything. I had such high hopes for this school!

I had a meeting with the principal, which went well. She was sympathetic and agreed to set up another IEP meeting, but we weren't able to get it scheduled until mid-September.

However, the situation with the classroom teacher and aide have gone from bad to worse. My son is having a hard time, basically perseverative talk and crying fits when he gets home, but the teacher flat-out refuses to meet or discuss this with me. I get the feeling she wants me to put him in another teacher's class- which I will definitely ask to do. My son is a great kid and I definitely don't want him in her class if she doesn't want him there, period.

I am this close to pulling him out and homeschooling. After meeting the teacher, my husband is now of the same opinion. He said he has never met such a mean, cold-hearted person in his entire life. However, the principal is quite reasonable and all the other teachers I've ever met have all been warm and personable, so I suppose we need to try another teacher first. But I'm not waiting until mid-September, when my child's already fragile psyche will have been completely crushed. I'm calling the principal tomorrow to tell her that I will plan to keep him home until we can resolve these issues.

I haven't slept much in two weeks as I constantly am stressed about this school situation. It's eating every ounce of my energy. I should be getting ready for my first lecture of fall semester that I have to give later this week, but I can't concentrate on anything other than this evil, evil kindergarten teacher. How anyone like this woman is allowed around small children, much less special needs kids, is beyond me.

Well, in the inimitable words of Kurt Vonnegut, "The stinky excrement has hit the spinning cooling device" or something to that effect. We had a full-scale meltdown this morning and as a result, didn't make it to school. We've had more perseverative language and crying jags for the past two weeks, but this morning I literally couldn't get him out the door to school.
So that settles that- I got a physician's note excusing him from school until our next IEP meeting. Even then, I suspect that I will probably end up announcing my decision to homeschool. The school is clearly in violation of his written IEP- which is causing him severe anxiety, yet no one seems to care. His classroom teacher, despite repeated pleas on my part, repeatedly replied that she is too busy to meet with me. When I asked whether I could meet with the classroom assistant instead, the teacher informed me that the assistant didn't have any time in her schedule, either. He's supposed to have a one-on-one aide per his IEP, but that didn't happen, either. Nor did anyone get RDI training as was specified in the IEP. So my child is suffering and no one even cares. They all just seem to think I'm some overbearing, pushy mom trying to tell them how to run their school.
Even if we somehow work out a satisfactory solution at our IEP meeting, I fear irreparable damage has already been done in terms of my relationship with the school staff. No one seems to understand that all I am doing is advocating for my child. My precious child, who cannot stand up for himself. My wonderful sweet child, who has made such great strides in remediating his autism over the past couple of years.
So...it looks like I will, in all likelihood, be a homeschooler by default. So that is that. We'll give the IEP meeting a try, but I'm not at all optimistic, not after all we've been through.
At least we have a nice long weekend to relax, unwind, and hopefully forget about the horrible week we've just had.

Well, we finally had our IEP meeting and the results are a mixed bag. It turns out that his IEP never specified that he was to receive a "one-to-one aide", just "an aide"- which can include a shared classroom assistant, apparently. Just a case of me not understanding the language or them deliberately tricking me or perhaps both. I would never have agreed to school attendance without a one-to-one aide, so I do believe I was misled, whether intentionally or inadvertently.

At this latest meeting, they still refused to provide a one-to-one aide, insisting that his problems could be remediated simply through more effective communication with teachers. While I certainly agree that better communication is critical, I still feel that, based on my own firsthand experience, a shared aide is grossly insufficient to meet his needs. However, I was very impressed with the new teacher to which he will be assigned. She's a young woman, sounds very receptive, caring, and accommodating, and I'd like to give it a try in her class. She's indicated that she would be glad to meet with me as necessary, so that's certainly a good sign. A big change from the old teacher, who absolutely never had any time whatsoever to talk with me, neither in person nor on the phone nor by email and she never responded to my written requests, either! Not even when I told her that my normally sweet, happy child was constantly in tears and acting more autistic than he had in 3 years!

So we're going to start with him attending only three half-hour sessions of small group work per week. The kids in the classroom will be divided into small groups of 4 kids and each group assigned to a different area of the classroom. There will be one other disabled child (not autistic) in his group and a shared aide will be responsible for both. We'll give it a try and see how it goes. I'm not going to allow him to go to music or PE or any of the large-classroom activities because I know that a shared aide would just not work in a situation with 20 or more kids.

Honestly, after all we've been through already, I'm really hesitant even to try the small groups with a shared aide. But I guess I will give it a try. The bottom line is, the kid wants to go to kindergarten. So I'm going to try to make that possible for him. I'm going to meet the school halfway and agree to a shared aide for just those 3 sessions a week. I will not increase his hours until I've been assured that he will receive better support, so we may be in for more disputes in the future. But I refuse to make my child suffer any more just so I can prove that I'm right. If it comes down to it, I'll pull him out and homeschool and that will be that.

If it were up to me, I would have given up on this whole battle a long time ago. But I have to respect my child's wishes: he WANTS to go to kindergarten. He's not ready to go full day, but he really enjoyed the taste he got last year and he's eager to go back. After a 2-week hiatus, he's mostly forgotten the negative experiences he had earlier this year and is eager to start again in the new teacher's class. I sooooooo want this to work for him!!!

Monday's his first day. I hope all goes well.

So far, so good. From all appearances, today went well. The new teacher is orders of magnitude better- and the lines of communication are wide open. The other child for which the aide is responsible is a sweet little girl with developmental delay- of course, they're not allowed to tell me her diagnosis, but she appears to be socially normal and doesn't have behavioral problems. So I don't think the aide will be overwhelmed with these 2 children, as long as she doesn't become responsible for any more kids.

On a related note, I spoke with the principal and she told me that the old teacher was intimidated by me because I'm a doctor! Whoa! I can't imagine ME intimidating ANYONE! I mean, I teach community college freshmen and they all praise me for being so accessible and NON-intimidating!! And that's when I'm all dressed up and they address me by my Dr. title. When I'm at my son's school, I go by my first name and I basically look like a slob in my T-shirt and sandals- I may be short and overweight, but certainly not an intimidating personage! The only context I even mention my medical training in is to explain how important RDI is for him and that I found the mission of remediating autism so important that I quit my medical career, despite a massive amount of debt. I can't imagine why she found me to be intimidating. That is one description I have NEVER heard about myself, but I suppose there's a first time for everything. I just hate that it had to hurt my son. I wish that, if she had a problem with me, she would have taken it up with me rather than allowing her feelings toward me to adversely affect my son.

Well, good riddance to her. I'm glad we found this out early and dealt with it. I just hope things continue to go well with this new teacher. My wonderful son deserves to experience some success and happiness and I soooo hope the school allows that to happen!

I've been bummed for the last couple of days. My son hasn't been doing well- lots of perseverative crying fits and I just can't tell what's going on with him. I know this will probably pass and I know I should be grateful that he seldom gets like this anymore- but it's always difficult when things come crashing down again like this. Most of the time, I try to focus on how well he's been doing- and most of the time, that's true. But at times like this when he decompensates, all I do is worry about the future.
How ironic- I just recently posted in another forum that I'm enjoying every day of staying home. I suppose I should re-phrase that to say "I'm grateful for every day that I'm able to stay home and NOT be gone doing residency". Most of the time, we're pretty happy. When my son's autism flares up- we're all miserable- but I know we'd be much more miserable if I were a resident and gone all the time, leaving my husband to deal with this alone.
Add to that the fact that I've started worrying about money. The recent discussion in the physician's forum has got me questioning my sanity. The physicians in that forum are stressed out and unhappy- and feel trapped- and feel like they don't have a way out- and they all earn orders of magnitude more than I do or perhaps have physician spouses who earn more. I have just as much debt or perhaps more as any other physician. My husband and I, combined, have a low enough income to qualify for the Earned Income credit on our federal taxes. I earn just enough to pay the interest on my student loans, which is all I'm required to do for the first 10 years of repayment, so that's where my whopping $5K annual salary goes. Otherwise, we're fully dependent on my husband's salary, which is modest and not likely to increase much over time. And if I never do residency, which seems likely, I'll never have sufficient earning potential to make even a small dent in my student loans. Not to mention saving for retirement or buying a house.
What on earth have I gotten myself into? I must be insane.
But the bottom line is, I really don't see any other option right now. I guess I'll be ok once I feel like my son is actually making progress again. It's all worth it on the good days, which have increased dramatically in frequency since I've been home with him. These bad days are just a reminder of how far we've come and how far we still have to go.
Anyway, sorry for the negative ranting, but this is just how I feel after listening to THREE HOURS of nonsensical, perseverative crying fits! Hopefully tomorrow will be a better day!

Sorry for not updating sooner! We've had some computer/internet problems- then my older son fell and broke his arm, so we've had our hands full around here. Thanks so much for all the PM's- I really appreciate the support. All things considered, we've been doing remarkably well. No more crying fits and I was able to discern the reason for the crying fit 2 weeks ago- it turns out he was sad that I was leaving him alone at kindermusik! I used to always stay with him for Kindermusik, but one day the teacher asked if he could stay alone. I asked him if that was ok with him and he said that was fine. So, for the next several weeks, I would sit out in the hall with the other moms and chat while both boys were in Kindermusik. Well, it turns out he wasn't ok with it after all- it caused him to have huge anxiety which he wasn't able to verbalize at the time. He told me "I want mama to go to kindermusik with me because I like mama!" Well! I don't know why he wasn't able to verbalize that at the time. A neurotypical kid would just cry and scream "I want my mama!" until the teacher gave in. Not my kid- he holds back all his feelings, tries his best to conform to others' expectations- then, once he's home in a familiar environment, has a complete meltdown. Hopefully he'll learn the appropriate way to express his feelings at the appropriate time in the future.
But I'm actually THRILLED that he WANTS me to stay with him! This is a kid who used to be completely indifferent to my presence. When I was in medical school and would come home from a long day, he would completely ignore me. He acted as if I didn't even exist. Even when he was a baby, way before I ever had the slightest idea that he might be on the autism spectrum, I recall once commenting to my husband "You know, I get the feeling that he just thinks I'm some giant milk machine. It's like he could not care less about ME- he just wants my milk!" When my second son was born, I finally realized just how true this statement was because he absolutely adored me and always has. So for my older son to express a desire to have me stay in Kindermusik with him- well, I'm absolutely THRILLED! So what if most 5-year-olds are beyond that stage? My child may be at a stage more appropriate for a 1 or 2-year-old, but that's perfectly fine- at least he's gotten that far! And the last thing I want to do is destroy the trust he's developed in me by making him feel "abandoned". He'll let me know when he's ready to be more independent- and if that isn't until he's 8 or 9 or 10, so what? We'll get there. This is a kid who didn't drink from a cup or feed himself until he was almost 4, didn't potty-train until after his 4th birthday, who just recently at 5 1/2 learned to put socks and shoes (on the wrong foot half the time!) and shirt on (backwards). So, if he's developing separation anxiety at age 5 1/2- TERRIFIC!
So...thank God I have the opportunity to stay home with him and be here for him, now that he finally has an internal motivation to bond with me.
So all this really makes me think about homeschooling again. The school is not providing him a one-to-one aide and is talking about fading out any support whatsoever, because he acts fine at school. He's a very compliant child who doesn't give them any trouble, so they're ready to completely mainstream him. Personally, I know that's the worst possible thing they could possibly do to him right now. They just don't see how he's crying inside because, unlike so many other kids, he never shows his emotions. He never tantrums or hits or bites or screams or runs away or anything. So, if they continue to refuse to provide him the support he needs, I will end up homeschooling and that will be that.
Oh- and MIRACLE OF MIRACLES- he's EATING NEW FOODS!!! YAY!!! This is a kid who for 4 years, ate basically the same 3 foods and nothing more. FINALLY- in the last 2 months, he's added pizza, fish sticks, cheese sticks, and vanilla pudding to his diet! YAY!!!!! Now he's almost become a "typical kid" picky eater! I actually used a behavioral approach to get him to try new foods. However, it had never been effective before, so I think he had to be psychologically and cognitively ready- because I'd been trying to bribe the kid for YEARS to try new foods, but his lack of dynamic intelligence was preventing him even from accepting a bribe to try new foods. Now, I've faded out the bribes and he often asks for the new foods just because he likes them. Hooray! Perhaps someday we'll progress to eating vegetables and more, but for now, I'm just thrilled he's eating something besides peanut butter sandwiches!
So...about the homeschooling... who knows how I'll ever pay my loans back then? I do enjoy teaching- and it's so nice to get feedback from the students about how much they enjoy my class. I even have a couple of students who are failing, but they still tell me how much they enjoy my class. I try my best to encourage them by telling them about some of the candidates I evaluated while serving on my medical school's admissions committee. Every year, we admitted students with W's, D's, and F's on their transcript- provided they made up for the bad grades with a consistent pattern of good grades thereafter. And if a student is really, really bummed out- I may privately share that one of those students was myself- with 5 W's, 2 D's, and 2 F's my sophomore year in college- when I basically quit going to class and didn't bother to withdraw. I love what I do and I really enjoy serving in this mentor capacity to the students. And I get to talk about medicine- to a rapt audience! Sure, a lot of the basic science is dull, but I can really see their eyes light up whenever I mention clinical applications and especially when I share stories from my med school years. For example, when they're having to memorize all those ligaments of the female reproductive system, I'll tell them WHY this is important. I show them what happens when those ligaments fail- some really gross pictures of uterine prolapse, cystocele, and rectocele. I'll relate a rather self-deprecating anecdote or two about my experiences scrubbing in on GYN surgeries as a lowly MS3. Whenever possible, I try to work in some preventive health awareness without sounding preachy- for example, I'll tell them about the patient I saw who had nearly died of advanced cervical cancer- she had survived only after complete pelvic exteneration, requiring removal of the colon, bladder, vagina, uterus, tubes, and ovaries. It was basically a medical miracle that she survived- and all because she missed getting her Pap exam for ten years (because she didn't feel comfortable with the doctor.) And so on.
OK, I am rambling away now- and it's getting late, so enough for tonight. Thanks for reading this far!

Your story is amazing. May God continue to bless you and your family.

great blog. Very touching. I am an MD and have 3 kids, awaiting our 4th in a couple of months. My husband just started to work and with our expenses it is impossible for me to stay home to ake care of our kids. Always a dilemma. I love my profession, but as you mention it is very demanding. I am hoping to stay home in the future, but it does not look to be very near future. Residency was grueling. Even the most family oriented program is grueling, given the fact you are training to be an attending physician with full responsiblity of peoples lives. If I could do it all over again I would think twice before going into medicine, knowing what I know now, and loving our little ones so much.

Let's see- it's been several months since I've updated AGAIN! We're all well here. My older son is still attending school part-time and doing fine. Of course, it's a constant struggle to make sure the school holds up their end of our agreement- and they don't always do that- and often try to cut corners- so I have to stay on top of them all the time. I do like the principal and the new teacher, but I'm less than thrilled with some of the others involved. But as long as my son WANTS to go to school, I'll keep fighting the battle with the powers that be to make this possible for him. But- if he starts developing too much anxiety, I'm prepared to pull him out and homeschool in a heartbeat. So, we basically take it day by day for now.

As for my part-time career as an adjunct faculty, that's going really well. I just got my evaluations back from last semester and they were fantastic! "Best teacher I've ever had" ..."I wish she taught more classes", etc. etc. I'm thinking- wow! Maybe this career DOES have some potential for me. In fact, the college currently has an opening for full-time biology faculty and I could probably get the job if I wanted it, but I know I just can't commit to a full-time job right now. Still, it's nice to know I might have that option someday- it's a 9-months/year tenure-track appointment, fantastic state benefits, not sure about the pay but I'm guesstimating at least $50K or so. And the bottom line is- I really do enjoy it. And I'm GOOD at it. And if I REALLY scrimp and save, maybe I could eventually pay loans off on it. But, for now, I'll just have to stick with 1-2 classes per semester for what basically amounts to minimum wage.

So this makes it REALLY hard to get motivated to study for Step 3! I've only got 2 years left before my 7-year eligibility period expires- and then I would have to retake all three steps including CS and I am telling you, there is NO WAY I could EVER go through all that again! So, I really need to get it in gear here and STUDY!

Problem is, I just can't ever see myself doing a residency. I refuse to leave my older son alone until he's able to verbalize his needs and take care of himself (like his 3-year-old younger brother already does so well!) I guess someday my kids will be grown and hopefully both independent and maybe then? I don't know. I'm actually looking forward to spending some time with my husband when that day comes. We still have basically no relationship- we live in the same house and he works and I pay the bills and we both watch the kids and help each other with the chores and that's about it. It's not that we fight a lot or anything- we just don't have a marriage! It's like we're both live-in nannies or something. And it's been that way for several years now and shows no signs of changing. And since we have no help with the kids, there's really no easy answer. I suppose we'll just keep plugging along...

But, marital issues notwithstanding, I'm still thankful for my husband. I'm thankful that he supports me, both emotionally and financially. I'm thankful that he spends all his free time home with the kids. I'm thankful that I'm able to stay home with my son- even if it means my $155K of debt may never get paid. My DH earns enough to put a roof over our head and food on the table- so thankfully, my income isn't essential to our survival.

And while we're on the subject of giving thanks-
I'm thankful for all the huge strides my son has made over the last few years. I'm thankful that I discovered RDI and that it's equipped me with the tools to help my son develop to his fullest potential. I'm thankful that his younger brother shows no signs of autism. I'm sure there's a lot more to be thankful for, but that's just off the top of my head. And it's getting late and I'm starting to ramble yet again, so let's call it a night.

Dear SAHM MD,I have spent the last few days reading your blog and it has been both heart wrenching and at the same time strengthening for me.I admire you!

I am also a mom of 3,I completed 2 years of residency, had my 3rd child,my program closed and I was unable to find a place to do my final year.I'm still hoping but I've been a sahm for 9 months now and I'm grateful for the oppurtunity o be able to spend this time with my children.

I wish you well...you are a fighter and I know your sons will turn out perfect.

Wow, where has the time gone, once again? Busy, busy, busy....Where to begin?

I am still teaching part-time at the same community college and LOVING it. Recently, I started teaching online courses as well- which is definitely different from teaching a live class. Actually, I don't like it nearly as much as a live class, but it does give me the opportunity to work more hours from home. And with gas prices near $4 per gallon, that's a good thing! I still absolutely love, love, love my on-campus anatomy and physiology class. The students tell me over and over again how much they enjoy my lectures- and I really enjoy being a mentor to the next generation of healthcare professionals. I could totally see myself doing this full-time if I had someone to watch the kids. I'd never get rich doing it, but I think I could make ends meet. Maybe someday, when the kids are older...

My 6-year-old is now officially homeschooled and I am his primary teacher. I'm enjoying that as well. It gives us tons of time to work on things that are really important for him- like socializing with other kids at frequent playdates, homeschool group meetings, preschool activities, etc. He's a bright kid who is academically way ahead of his grade level, so our formal school work is quickly accomplished. Instead, I use every possible opportunity to work on the things that he needs help with the most. I'm not happy with how things have (not) worked out with his school- he really wanted to go to school, but the powers-that-be refused to work with us to make it possible for us. It's a long story that I don't feel like going into all the gory details right now. Actually, if I could afford it, I'd love to hire an attorney and take this one to court. But I can't, so that's that. I'm hopeful that, with continued intervention, he will someday be able to function independently with typical peers. Right now, I try to keep him with younger kids, like 3 or 4 year-olds, as much as possible, because developmentally, he's more on that level. His speech is more like a 4-year-old and I've found that he can hold his own with that age group. He doesn't feel the least bit out of place, even though he's a head or two taller than the younger kids. So that's why we do Kindermusik, gym classes, storytelling, etc. with the preschool crowd. He's even starting to tell kids to "STOP!" when they are physically aggressive towards him- which would have been impossible for him a year ago! He's even made a couple of friends among the younger kids- which is something I would never have DREAMED possible just a year or two ago. He's making tremendous progress and I am so thankful for that.

His younger brother is 3 1/2 and doing well. A bit high-needs, but a sweet kid and exceedingly bright (Actually, he's almost scary smart- like doing 2-digit addition in his head!)

I know a couple of moms that I've become friends with over the past few months. I've met even more in the homeschool group meetings. I'm definitely feeling a lot less isolated these days.

And I'm actually making myself study for Step 3 on the side. I have less than 18 months of eligibility left before I have to repeat all 3 steps. So...my plan is to take Step 3 sometime in 2009, then if I don't pass on the first try, try again in 2010. Hopefully it won't come to that. I scored in the 230's on both Steps 1 and 2, but of course, that was years ago when I was actively engaged in the study of medicine. But I'm told that Step 3 is supposed to be the easiest of the three, so hopefully that will prove to be the case for me as well.

Really, I'm not sure why I'm even bothering to study for Step 3...I don't see how I could ever do a residency without destroying my family. But I guess I just don't want to slam that door shut forever...you never know, right? Maybe when the kids are grown and have their own lives...

Many of my colleagues from med school have now finished residency and are practicing medicine. Now that IS a sobering thought. I could be earning 6-figures right now. I have the same amount of debt (or more!) as they do, but I will probably never earn enough money to pay off that debt. My economic hardship deferment expires this year and after that, I can apply for up to three years of forbearance. After that, I will have to pay up. Well, maybe by then I'll have a full-time job teaching online. Maybe I can do that and homeschool at the same time as the kids get older. Guess we'll just have to keep taking things one day at a time.

So there's the update from this end...if anyone is still out there reading! I'll try to update more frequently if anyone's interested.

Hi SAHM mom,
I am a pediatrician, and currently just volunteer once a week in the evening at a clinic for the uninsured. I am homeschooling my three children 9y, 71/2y and 4 y. I am teaching quite a bit to my kids as well as others.
PM me. I would love to chat and compare notes. Hope to chat soon.

Hi SAHM mom,
Keep up the good work, you are an inspiration to many. I finally delivered our 4th child and went into postpartum depression. I went out of work for a couple of months only to go back and then to come out again. I don't feel the same and feel very down. I wish you the best.

Yikes, has it really been almost 2 years since my last update? Have I really been that busy, busy, busy?
Let's see...where to start? First off, I am still primarily a SAHM, MD, now homeschooling both children (They are now 5 and 8). I am also still teaching A&P at the local community college, but now teach most of my courses online, so am able to assume a heavier workload. Online teaching works out well, as I get most of my work done late at night after everyone's in bed.
As for my student loans, I've found a work-around solution: the new Income-Based Repayment loan. I re-consolidated all of my loans with the federal government, which made me eligible for a new 3 years of economic hardship deferment, after which I will pay a monthly payment based on family income (I think it works out to around $300 per month, which is less than the interest payment on my loans!) After 25 years of repayment (including deferment), any remaining balance on my loans will be forgiven. However, if I work full-time in public service (that includes teaching at a state community college!) then the remaining balance will be forgiven after just 10 years of consecutive payments. Of course, I am not working full-time right now, so my current job doesn't count toward the 10 years, but I can see that becoming a possibility at some point in the future. So, no huge worries about the student loans. If I ever end up going back to practice medicine, I will someday be able to afford the payments to pay the loans off in full. If I never go back to earn a physician's salary, then eventually my loans will be forgiven, at least by the time I reach retirement age. So, that's a huge relief!
I also finally attempted Step 3 just last week (just a week shy of the 7-year deadline!) Gee, and I thought Step 1 was bad...Step 3 was an utterly EXHAUSTING 2 days! I feel as though I failed miserably, but I won't know for sure for 3-4 weeks. Obviously, there is a reason most people take this test after at least a year or two of residency. My lack of clinical experience hurt me the most on the CCS cases- I know I seriously messed up several of them. I guess I'll just have to wait and see what the results show. At this point, I would be thrilled to settle for passing Step 3 by one point, just so I don't have to worry about it ever again.
Of course, the chances of my doing residency at this point are quite slim. Most programs in the U.S. explicitly reject applicants who have been out of medical school for more than 5 years (or even 2 years, in many cases!). On the other hand, many FP and IM programs aren't all that competitive and maybe some program somewhere might give me a chance, someday.
My husband and I have discussed the subject of residency repeatedly- he thinks I should try to go back at some point. He also says he would love to be a SAHD again, now that the kids are older. However, we both agree that 80 hours per week is still just too much time for me to be away from the kids. Not to mention- I don't think he has the discipline to homeschool the kids, at least not right now. And we will definitely plan to continue to homeschool, for the benefit of my older son, who is really flourishing (more on that later.)
So- I will likely plan to remain SAHM, MD for the near future. However, IF I end up passing Step 3 (and that's a VERY big IF!) maybe I can start asking around if anyone would even consider my application at some point in the future, maybe in a couple of years when the kids are older. If so, we can start to seriously consider if/when this might be a possibility and if it would be workable for our family. If not, I will just have to forget about clinical medicine- and continue pursuing an alternate career in teaching (which I love, but unfortunately it pays a small fraction of a physician's salary.)
OK, I promised to update on my older son and how he's doing, but my eyes are glazing over from fatigue, so that will just have to wait until next time. I promise, I won't wait 2 years this time!

As promised, here's the update on my 8-year old: overall, he is doing terrific!

I have been homeschooling him for almost 2 years and it has worked out remarkably well, far surpassing my greatest expectations. Academically, he is working at or above grade level in just about every subject. He does have some attention deficit issues, but fortunately he learns things fairly quickly and I do my best to break up his day to optimize his learning potential. I just have to brag on his handwriting: I am blown away by how easily he has learned cursive...he writes beautifully, far better than my own best efforts! And just think, this is the same kid who could barely print his name just 2 years ago! And the OT's told me he would likely never be capable of writing much, so he would probably require an assistive typing device for the rest of his life! NOT!

We typically spend less than an hour daily on formal "sit down" schoolwork so we are able to devote most of the day to extra-curricular activities (i.e., lots of opportunities to practice following group directions, socialization and independence...) He's involved in a huge variety of extra-curricular activities: he's been taking violin lessons for over 2 years and piano for almost a year. He also takes gymnastics lessons and after several months of begging, started taking ballet lessons (after he saw the "Nutcracker" in 2008). In the past year, he started playing violin with a youth orchestra and got to play onstage in a formal concert (black tuxedo and all!) He also fulfilled a dream by dancing in his ballet school's production of the "Nutcracker" last December (he was a cherub). Amazingly enough, he also played baseball on a Little League team last spring. Most people who know him have absolutely no idea that he is (or was?) on the autism spectrum. He does still have significant speech articulation delays, so it's sometimes difficult for strangers to understand him, but that is improving too, over time. (His pronunciation is probably more like that of a typical 4 year old...which is itself a significant improvement from when HE was 4 years old- at that time, his speech was virtually unintelligible to anyone other than his dad and I.)

We have a core group of homeschooling families that we hang out with on a regular basis, have playdates at each other's houses, go on field trips together, etc. My son doesn't really have a "close" friend among these kids, but he does enjoy being in their company and having them over, maybe playing a game of pick-up baseball with them on occasion. His best friend is actually his younger brother, who is now 5. The two of them spend most of the day playing together, so they occupy each other nicely. Of course, they also fight, like any siblings, but on the whole, they are very good playmates. In fact, I suspect that's why my son doesn't really feel the need to seek out other kids too much, because he enjoys playing with his brother so much.

On a personal level, he has become extremely affectionate to me over the past year or so. I never would have thought it possible. Just about every day, he hugs me and tells me how sweet I am and how much he loves me. It's so unreal, it's like a dream. I can't believe this is the same kid who, at age 2, appeared completely indifferent to my presence, who never, ever returned a hug or kiss. Wow, it is truly amazing how far he has come.

Tantrums? Never. Crying fits? I think I can count on one hand the number of crying fits he's had in the past year. Sensory issues? Well, he still has a restricted range of foods he'll eat, but that is improving. Other than that, I can't really think of anything.

So is he "cured"? No. He has come a long, long way, but there is still a lot to be learned before he will be able to function independently in this world. For example, he is still far too passive and far too compliant. He lets other kids break in front of him in line, push him out of the way, and even hit him without defending himself. On his baseball team, for example, I once observed another child hitting him- and he was unsuccessful in getting the child to stop or in getting the Coach's attention. He is still very slow to react- so he's always the last kid to get back in the dugout or back on the field. He sometimes "spaces out" and forgets what he is supposed to be doing (which, again, is developmentally more in line with a 4 or 5-year-old than an 8-year-old- but it's still progress!) He often has a tendency to ramble on and on, without checking in to see if anyone is listening. He also tends to talk to himself out loud for sustained periods of time- and I've heard other kids make fun of him for this, as well as for his speech difficulties. So, he still has a lot of challenges to face- but fortunately, he isn't really aware of it and so he doesn't suffer under that burden. He's a really happy kid, with a very strong self-image. I know that, if he were in school, this wouldn't be the case, because there is no way he could possibly fend for himself for 7 hours a day- that would be like throwing him to the wolves. Instead, I am trying to teach him the skills he needs to function independently, but I do it at his pace- so he goes to his classes and other activities for just an hour or two at a time. I try to always be nearby to observe from a distance and, later, interpret for him what happened and offer him suggestions for how to improve his functioning in the future. So, regarding the talking out loud, I might say "You know, while you were in the dugout, the boy next to you seemed to be annoyed by your talking out loud for so long- that's why he and the other boy were laughing." Then I might suggest that he should keep his thoughts to himself, just think them quietly, unless there's something in particular that he wants to share with others. And so on...the work continues!

So, that's why I'm still SAHMDOC, MD. It's all been worth it so far. If someone could have told me five years ago, when I started this blog, that my child would be playing violin in a youth orchestra or playing baseball on a Little League team, I would never have believed it possible. I am so thankful that I have had this opportunity to be here for him the past five years. We have come such an extraordinarily long way...there are still challenges to be overcome, but I continue to be hopeful for the future. So, even if it turns out that I will never be able to go back and do residency, never be able to live my dream of practicing medicine, it's all been worth it so far. I have no regrets.

So here is the post I've been dreaming of making for the past five years...
Step 3 scores were released at midnight. The verdict is in...I passed! I actually passed quite comfortably. HOORAY! What a relief! So I passed despite complete lack of recent clinical experience and not sleeping a wink the night before the exam. I also felt like I had completely messed up several of the clinical case studies, but that turned out to be one of my strong areas.
So, for anyone out there contemplating Step 3 without residency: I'm proof that it CAN be done. I've basically been studying for this one on a very intermittent basis for the past 5 years (basically, since medical school graduation). If anyone's interested- I primarily used Master the Boards, and the Kaplan Qbook, which I carried around with me wherever I went (Kids' gym, orchestra rehearsals, etc.) I completed the entire question bank on USMLEWorld twice, scoring roughly 50% the first time around and 60% the second time. I also did all of the CCS cases in USMLE World twice. I took the NBME self-assessment a week prior to the real thing and scored 560, which translates I think to 220 or so. I also took the USMLE World self-assessment prior to the real thing and scored in the low 200's.
Actual score: 225/96.

Now, who knows if I will ever be in a position to actually do a residency, but at least I have kept that door open by successfully passing all 3 Steps within the requisite 7-year period. Bye, bye USMLE!

It seems that every time I get on the computer these days, up pops some horrible headline like this one:

Mom, Autistic Son Dead in Suspected Murder-Suicide; Note Said Bronx Mom was "Overwhelmed"

Last week, it was this one:
Texas Mom Says She Killed Kids Because They Were Austistic

I've read about cases like this several times over the years and obviously, this hits very close to home. How my heart aches for these kids...and for their parents. It's so horrible that these moms saw no other way to cope than to take their children's lives...and often their own lives as well.

In listening to radio chatter and reading people's comments, I'm struck by how many people are so quick to say that the parents "should have sought help". Newsflash: there isn't a whole lot of help out there. Especially not if you're an overwhelmed immigrant family in Texas or a working class single mom in the Bronx. If they only had the slightest idea of how difficult it is to live with a child with autism. Or how long the waiting list is even to get a few hours a month of respite care services.

Of course, I cannot possibly condone what any of these moms did. At the very least, the children deserved a chance. If all else failed, the parents could have at least taken their children to Child Protective Services and given them to a foster family. (Though- I would venture to guess- there aren't very many foster families willing to take on the huge challenges of dealing with a child with autism. Especially an older child with autism. A child who, depending on the severity of his autism, may literally bite the hand that feeds him. Or smear feces all over the living room carpet. Or break his mom's arm. All in the same day.) Still, I hope if there are any other parents out there in the same boat, they will at least try to give their child up rather than ever consider taking such a horrendous, irreversible step.

I'm very fortunate. My child has never done any of the above. Well, I take that back- he did bite me once, but that's when he was a teething toddler. Even during those horrible, prolonged, inexplicable fits of rage that plagued him as a young child- he never displayed a single act of aggression toward anyone else. He's now the sweetest, most mellow (downright passive!) child I've ever met. (Matter of fact, I'm planning to enroll him in karate so he can learn to become a little MORE assertive and learn some self-defense skills, because he still allows other kids to pick on him, push him around, and hit him.)

But I didn't know all this when he was 1 or 2. When, for no apparent reason, he would scream for hours on end, completely inconsolable, no matter how much we tried to comfort him. Obviously, he wasn't able to communicate his needs to us- and so he reacted the only way he knew how- by thrashing on the floor and screaming. Fortunately, that problem has improved progressively over time, as he's gotten older, as we grew to understand him better, and as he's learned to communicate better. Today, he is actually much easier to discipline than his neurotypical younger brother. We are so blessed.

Some parents aren't so lucky. Some parents have 12-year-olds with autism who still cannot communicate adequately to convey their needs. But when a 100-pound 12-year-old (or 150 pound 16-year-old) has a meltdown- it is very different than a little toddler. It can be dangerous, even life-threatening, for both parent and child. I cannot begin to imagine what it must be like to be the parent of this child. I'm so glad I didn't know about these cases when my son was younger. You see, back then, I had no idea of how he was going to turn out. For all I knew, he was always going to be completely in his own world, utterly indifferent to my presence, obsessed only with trains and wheels and things that spin, and screaming for hours on end for no apparent reason.

Even on the worst days, I never thought of harming him, but I will make this confession: there were plenty of times that I wished he had never been born. Especially in the beginning, when we first got the diagnosis, at age 15 months. It seems unfathomable to me now that I could ever have wished this terrific kid had never been born, but the fact is, it wasn't always so terrific. Some days (and nights) were utter nightmares.

But I was lucky. I had a husband who completely abandoned his career path and quit his job to stay home and work with our child. Two years later, he went back to work and then I quit residency to stay home. We both completely devoted our entire lives to helping our son: researching our legal rights (arguing with his service coordinator), investigating therapies, advocating for him at countless IEP meetings (arguing with his service coordinator...), implementing our own home-based therapies when the schools refused to do their share (and arguing with his service coordinator...) It was basically a constant fight with the powers-that-be. It seems they always wanted to cut our son's therapy hours or eliminate his therapies entirely. It was emotionally draining and physically exhausting, not to mention financially devastating, as we ended up depleting our entire retirement savings and taking out extra loans to pay for therapies out-of-pocket when the schools refused to pay. Not to mention it required us to completely sacrifice our own lives, including our marriage, friends, and careers.

And it has all been worth it. My son is a prime example of what can happen with very early, intensive intervention. All of our sacrifices have been worth it thousand-fold. Our marriage has been very rocky at times, but it has survived. Even our finances will recover eventually, now that we no longer have to pay for all of these expensive therapies.

But what about those many, many parents who WEREN'T in our position? Maybe there is no dad. Maybe the parents don't speak English. Maybe mom is too busy working to pay the bills to be able to quit her job and assume full-time responsibility for caring for an autistic child. So this child gets left completely at the mercy of the system. And depending on how adequate this system is- as that child gets older, he may never get the help he needs...which may then lead to these horrible scenarios like we've been hearing in the news.

So...I'm not sure exactly where I was planning to go with this post...and it's getting late and I'm starting to ramble...but I just wish there were something I could do to prevent these horrendous headlines from ever appearing again. I wish parents of autistic kids everywhere could get the services they need to help their children. Maybe not all autistic children will turn out to be as high-functioning as my son...but it would be enough if their quality of life improved enough to be able to function in this world, to be happy and enjoy life with their families, and to lesson their burden on their families. I wish every child with autism could have the same opportunities for recovery that my child has had. I am so thankful for my son and I wish every parent could say the same for their child.

Lots of things running through my mind right now...and it's late, so I'm probably not going to be very coherent...but let's give it a try.

First off...I miss medicine. I had to take my kids to the pediatrician this week and I really HATED having to take them in...A) because it's a hassle B) because it costs money C) because that office is FULL of germs and D) because I know I could diagnose and treat them on my own anyway (and yes, I KNOW that is poor form...) I could plainly see the beefy red tonsils on both kids, the whitish exudate on one of them, plus the history of a recent playdate of a child dx'ed with strep. If I were a practicing physician...I could have ordered their rapid strep screens, sent out their throat cultures, and calculated their respective Duricef doses. But instead, since I am NOT a licensed physician, I had to do what all the other SAHM's do...drag them in to the crowded pediatrician's office, spend half the day in the waiting room...only to have someone else bill me to tell me exactly what I already knew had to be done. It's almost like...I don't know...almost insulting that I have to go to all that trouble when I know exactly what needs to be done.

And the pediatrician...I like her, but I am not her intellectual peer, at least she doesn't treat me as one. Because I am NOT her colleague and probably never will be...I haven't done a day of residency training and probably never will. Yes, I've passed Step 3, which supposedly evaluates a physician's ability to practice unsupervised medicine...but in the end, passing Step 3 is meaningless without at least a year of internship. And that year of internship is brutal under the best of circumstances...so out of the question for us.

My best friend from med school...the one who went through the trenches with me in Gross Anatomy? She's now in practice earning $400K per year. I was thrilled to hear that my old bosom buddy had made it into the big-time... We spent one late night chatting online- but since then she hasn't replied to my emails anymore...I feel like she's in a whole different world from me and no longer views me as her colleague either. She did mention once that I should at least do an internship and then get a part-time job in an institution...she gets paid $150 per hour to moonlight as a prison physician on weekends. But again, that's 80 hours per week- so internship is out of the question.

My medical school is sending me letters requesting donations, now that I'm supposedly a rich physician in practice. I have 2nd year medical students calling me asking me to donate to their scholarship fund. I got a "Dear Dr." letter from a local bank addressed to me personally, inviting me to apply for a new account "reserved for our affluent customers..." (LOL! NO idea how they got that idea! Obviously, they didn't look at the balance in my bank account. Maybe they somehow saw the balance on my student loans and assumed only a physician could possibly have so much debt?)

And here I am...SAHM, MD, barely making ends meet. Well, not exactly...we're not poor or starving, my husband has a decent job, we have health insurance...and our kids are growing up with far more opportunities than either of us ever had...but we will never be anywhere close to affluent. Not that I've ever cared about having money...it's just kind of surreal seeing how all my friends from med school are now part of this whole new world and only I am on the outside looking in. So I skipped my 5-year med school reunion...it wasn't just because I can't afford to pay the registration fees, but also- because I feel like a complete and utter outsider now. Frankly, I feel like an impostor anytime a student addresses me by my Dr. title.

So...I don't know exactly what prompted me to write this post...I certainly have no regrets about any of my decisions over the past 5 years. I'm soooo immensely thankful that I've had the opportunity to be here for my son all these years...and for all the incredible progress he's made and how far he has come. Every day, I give a silent prayer of thanks that my son, after all he's been through, is now a happy, loving, thriving child.

I guess I'm just feeling a bit wistful about "what could have been"...there is still a whiny little part of me that is wondering why I don't get to be a physician, too. And it's not the money...it's something about having the quiet confidence and authority that my children's pediatrician has...I just can't quite explain it. Becoming a physician was my dream for so long...and I accomplished that goal on paper, but was never able to truly live out the dream.

I guess the problem is no one really understands how I feel. I have lots of SAHM friends who gave up their careers to homeschool...one was a teacher, one a nurse, one was even an attorney- but I am the only MD. I have one MD friend in full-time practice...she actually DOES treat me as a colleague- she has 3 kids and is very happy in her specialty....we have coffee together on occasion...she is always very supportive and encouraging, but of course, she is in full-time practice, so can't really relate to how I feel. So...no one can really understand how conflicted I feel. My SAHM friends completely understand why I would give up a career as a physician to stay home with my children...they made similar choices themselves. But I suspect most of them haven't given up a career quite as promising as medicine. My former med school friends know exactly what I've given up by not practicing medicine...and they think I'm utterly insane for doing so...but they just can't understand the depth of my commitment to my special needs child. So there we are...

OK, enough rambling now...thanks for reading this pitiful jumbled mess of random musings! I'm going to mull over this some more and see where it takes me...good night!

Read the whole blog and really this would make a great book. So many moms of autistic and regular children would benefit. I also was a SAHM for 16 years! Plus you are REALLY funny!
I just returned to work this year after noone would hire me for forever. I found a job doing disability exams. You could easily do this one day a week and make $1000 in a day. Anyway, just wanted to throw that out there for any other SAHM MomMD's who are looking to return after having dropped out for years.
Anyway, looking forward to reading your book (ebook?) and then get movie options....ok, getting carried away here. Also then you could do lectures with even more credibility: MD, experience AND published author.

Yikes! I've been soooo busy lately- haven't even had time to pull up MomMD in months! I don't have much time now- but wanted to post a quick update....
First of all, lots of changes (all good!) in my personal life the last few months...in short, I actually have a LIFE! Yes, indeed...besides homeschooling (still doing that) and teaching A&P (still ongoing)...I've become very close friends with another homeschooling mom- who has been the most amazing friend I've ever had in my life. She's really supported me, encouraged me, been there for me- helped me to really discover myself and learn to take time for myself- easily the best friend I've ever had in my entire life (other than my husband perhaps). We talk to each other almost every day, regularly go out on girls' nights out together, our families all hang out together and we often watch each other's kids...in fact, she is the ONLY person I have ever left either of my children with, besides my husband or my mom (the latter on rare occasions.) I adore her kids as if they were my own- and they treat me as if I were their beloved Auntie or something. My kids tell me they wish SHE were their mom...that's how much they love her! Oh, did I mention her kids and my kids are best friends? How lucky we all are to have found one another!
Thanks to encouragement from my new BFF- I've started a work-out program and, over the past 4 months, managed to drop 18 pounds and 3 sizes, from a size 16 down to a size 10, a size I haven't worn in 15 years! She's also taken me shopping and basically helped me select a whole new wardrobe, encouraging me to ditch the androgynous baggy T-shirt and cut-off-shorts for a more feminine look... so now I look (and feel!) a lot better...I get compliments on my appearance everywhere I go...now that IS a first in my life!
And my relationship with DH...well, let's just say that we've found ways to find time for one another and are happily re-discovering one another (LOTS of time, ok?? <blush>
So is life perfect? Of course not...Homeschooling is often a struggle with my son's ADD issues- to the point that I've tried ADD meds, with mixed results (more on that another day). DH has a new job with longer hours (and less pay)- but he is SO much happier with what he's doing, it's worth the sacrifice. Life is far from perfect, but ...life is good! This is the happiest I've been in at least 10 years, maybe longer...I am so thankful to have my best friend in my life.
OK, back to work on my online course- more later!