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From med school to SAHM, MD

14 years 3 months ago #69768 by SAHMdoc
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.

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14 years 2 months ago #69769 by SAHMdoc
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.

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14 years 2 months ago #69770 by SAHMdoc
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.

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13 years 11 months ago #69771 by SAHMdoc
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.

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13 years 11 months ago #69772 by SAHMdoc
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.

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13 years 10 months ago #69773 by SAHMdoc
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!

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