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From med school to SAHM, MD

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14 years 1 month ago #69762 by SAHMdoc
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:

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14 years 1 month ago #69763 by SAHMdoc
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...

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14 years 1 month ago #69764 by SAHMdoc
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.

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14 years 1 month ago #69765 by SAHMdoc
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!

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14 years 4 weeks ago #69766 by SAHMdoc
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.

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14 years 3 weeks ago #69767 by SAHMdoc
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.

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