After I took a Human Anatomy/Physiology class in high school and loved every minute of it, I decided to go to med school. I was 16. I was going to heal the sick. Stamp out disease. Serve others. I was going to Make.A.Difference.
Sometimes I forget how idealistic teenagers can be.
I entered college as your typical Bio major/Chem minor. I held offices in honor societies, volunteered, worked as a CNA in the summer, did research, wrote an honors thesis; everything that we were told the admissions committees would be looking for. I met my future husband, and I developed what I would come to think of in my head as The Plan. Capital "T", capital "P".
The Plan had several phases, but essentially boiled down to getting married and starting med school immediately after graduating from college, FP residency for three years, first baby the summer after graduating from residency, work part-time after that. The Plan was not complicated, and not unlike the plans my pre-med friends had developed for themselves. I did, however, feel a sense of urgency that The Plan should be carried out in a timely matter, without any delays, sidetracks, navigational errors, etc.
My third year of college, I considered doing another minor in Spanish. Looking back, they were the only classes I truly enjoyed, and now I occasionally beat myself about the head and shoulders for not minoring, or even majoring in Spanish. But to do that would have required at least another 6 months of college, and that was DEFINITELY NOT part of The Plan.
I started med school on my 22nd birthday. I dragged my new husband and all of our worldly possessions to a completely different part of the country and away from friends and family. We both agree that it was the best thing that we could have done as a newly married couple. In such a situation, you have only each other to rely on and you will either sink or swim. Luckily, we are both pretty good swimmers.
Med school was great for me socially. I finally met people who were as OCD, Type A, "nerdy", high-achieving, and driven as I was. It took 22 years, but I had finally found my peer group. It also only took a few anatomy exams for me to realize that, with THESE peers, I was completely average (and many times, grateful to be so). The first two years were a blur of memorization and exams. I felt like I was running a marathon and just had to keep concentrating on putting one foot in front of the other.
I looked forward to the clinical years, because that was when med school REALLY started, right? I felt a little anxious because this little tiny voice of doubt kept whispering to me that maybe I had made a mistake. I felt like I shouldn't have to struggle so hard to stay focused, that I should at least find the patients interesting. But, I realize now that the reading I did during my clinical years was not out of intellectual curiosity, but out of a fierce desire not to look like a complete idiot during morning pimping rounds.
I did well my third and fourth years and managed to match at my first choice for residency, which brought my husband and I back home. It was good to have the support of friends and family again, and it would turn out to be desperately needed.
I have never been as unhealthy as I was during residency. I gained 30 pounds. I seemed to cry all the time, and I'm not easily moved to tears. I remember having horrible temperature dysregulation post-call in clinic where I would huddle at my desk with a blanket while dictating. On call, there were times when my brain was so fatigued, I know I must have made mistakes.
Through it all, there was light at the end of the proverbial tunnel. Doesn't everybody tell you that it's SO much better after residency? "Just hang in there". I felt like my arms were 10 feet long from hanging in there. Sometimes it was more like dangling.
Third year of residency, I was offered a jobshare position at a small private practice doing "traditional FP": admitting patients to the hospital, delivering babies, full clinic. I wouldn't be starting until January, because, per The Plan, I was supposed to get pregnant third year and deliver shortly after graduation. This would give me 3-6 months at home with my baby before starting my First Real Job.
Looking back now, I'm amazed that The Plan held together as long as it did. I guess it had to break down sometime. I mean, I pretty much got through my medical education due to sheer will and stubborness. Unfortunately, you just can't will yourself to conceive, and that is when The Plan began to unravel.
Of course I had it all planned out. That's just the way I did things. Third year of residency, I had a three month window in which to conceive and not delay my graduation BUT still have a decent amount of time to stay home with my kid before starting The Job. It's just...laughable, looking back on it now. But at the time, I really thought it was just going to happen. It's not like I hadn't counseled patients on conception before. I even invested in the super-giganto pack of ovulation tests from Costco.
Well, the Window of Conception came and went, and for the first time, there was a breakdown in The Plan. I had already signed my contract with my new job and wasn't due to start until January, and so I decided to enjoy this unexpected time off. After taking the FP boards, I went on several business trips with my poor neglected husband, got a trainer and lost the "Residency 30", read books that had nothing to do with medicine whatsoever, and rehabilitated my yard. It was great. I hadn't been that happy in YEARS!
For all appearances, it seemed that I had managed to find The Dream Job. It was a small private practice in a nice suburban community. I would be jobsharing with the only female partner, and if I liked it, I could buy into the practice. Call it an omen, I knew I was in trouble when an elderly woman I was seeing as a drop-in patient for "a little breathing trouble" coded in the exam room and later died in the ICU on my VERY FIRST DAY.
:: sigh ::
Well, dreams can also become nightmares and that is what happened with this job. I'm not really one of those people who believes that "everything happens for a reason" but I am so lucky we didn't get pregnant during residency because dealing with this job and a baby would have completely sent me over the edge. My jobshare partner had communication issues, in that she simply didn't. Her charting was crappy at best, and it was not uncommon for me to see one of her patients for "follow-up" on an issue (undocumented) being treated with a medication (also undocumented). I felt like I would do better if I got a great big hat and held charts up to my head like Johnny Carson's Karnac.
After only three months, I found myself longing for residency. How WARPED is that? But at least in residency, I trusted my partners to give good signout and my patients had actual MEDICAL issues. I tired very quickly of seeing self-entitled patients who just wanted me to give them the Magic Pill that would help them sleep, improve their mood, cure menopause, and make them lose 20 pounds, all by next month. The practice was poorly run, and although I was supposedly part-time, I was on call 24/7 for my OB patients, and took call in the same rotation as my full-time partners.
I was horribly stressed, because I really wanted to make this job work, but we also wanted to start our family and I knew that with my husband's job taking him out of town 2-3 times a month, and my inability to predict when somebody would go into labor or need to be admitted, we would need to get a live-in nanny. Why bother having kids if you aren't going to be around to raise them? This is when I revised The Plan. I would stick it out at The Job for a year and in that time we would work on getting pregnant. I didn't want to burn any bridges, and so if the job situation didn't improve, I could give my notice and blame it on needing a job that had no OB, and no inpatient work instead of my inability to tolerate the Clinic of Chaos. My decision was made the day my jobshare partner told me that she only took 2 weeks off from work with their second baby, and that I "should really think about how much time you want to take off because it's really going to place a burden on the rest of the partners."
Two weeks? Ha! Bye-bye nightmare first job!
I was six months pregnant when I stopped working and I didn't see the point in starting a new job just to go on maternity leave. So, I happily gestated. I went to movies, organized lunches with my physician friends, did a little nesting. The New Plan involved finding a job at an urgent care when my kidlet was 3 or 4 months old. Not ideal for an FP who is trained to build relationships with patients and provide continuity of care, but at least I could work in the evenings when my husband could be home, and there would be no call.
Someday I will find a painting or sculpture that captures all of the emotions that come the first time you get to see and hold your baby, because I know that I just don't have the words. Everybody tells you how much your life will change; how the way you view the world will be completely different, but I don't think I even had a clue until my daughter was born.
We had barely gotten her settled into her bassinet at home when I started panicking. How could I leave her? How would I ever find a job that would work with our crazy schedule? Did I even WANT to go back to work? Was I a bad person/lazy/silly/crazy if I left medicine? I called the ABFP and my state's medical board to see what my options were. I wore out my husband with my constant anxieties.
I made a list:
-Money: Well, ironically, my husband makes more money with his 4 years of undergrad than I ever could working full-time as an FP, so it didn't make sense for him to stay home while I worked. We will never live in a mansion and drive 5 cars, but that's not really our style anyway. We have enough to make my school loan payments and save, and that's all I can really ask for, so money wasn't really the issue.
-Identity: You gotta admit that there's a big ego boost that goes along with being able to introduce yourself as Dr. so-and-so, but I never felt that being a doctor was tied to my identity. I remember one of my residency program directors telling me that she was a "physician first, everything else second." I just couldn't relate to that at time, and even less after having my baby. But I do have a "what will people think of me?" issue. I worried that I would come across as someone who just didn't care enough, or who just couldn't cut it. I have to constantly remind myself that I am doing what is best for me and my family and that the only thing that really matters is what I think of myself.
-"Wasted" time: I had pretty much lived and breathed the dream of becoming a physician since I was 16. Now, at the age of 30, I was going to throw away 14 years of hard, at times excruciating, work? I started to reflect on all of the experiences we have during the course of medical education: We are introduced to cultures from all over the world. We are the first people to touch a baby as it enters the world, and we sit with families as a patient is dying. Never in my life had I been as physically, mentally, and emotionally challenged as I was during the course of my medical education, and I can only hope that it made me a stronger person. The only thing I regret about the time I spent to become a physician was the post-call grumpiness my husband had to endure and the lonely call nights and holidays he had to spend without me.
Service-I truly believe that most people go into medicine with a sincere desire to serve others. (Sometimes the intoxicated patient you are trying to admit as they scream and bite at you may make you question this decision...) Some of my best days were when I saw a patient in clinic and they would say "I feel so much better." Because really, that's what it's all about, isn't it? But I know that there are many ways to serve others, many organizations in need of volunteers. You don't have to wear a pager and admit patients at 2am to make a difference.
When my baby was six weeks old, she giggled at me. It was amazing. And then I sat down and cried. What if a nanny or babysitter had seen that because I was at work? I knew that if I had been in residency when I had had her, I would be going back to work at that point. And I knew that I wouldn't have been able to do it. And that's when I knew that I would probably never work as a physician again.
My husband and I joke that you don't have to be a genius to become a doctor, you just have to be incredibly stubborn and willing to absorb an ungodly amount of school loan debt. After spending almost half of my life rigorously adhering to The Plan, I realized that with the arrival of my daughter, I was completely unhappy with what my life under The Plan would become. What I needed was an Anti-Plan.
After having such a regimented, detailed schedule for my life, getting used to the idea of living for the moment was very unsettling. But you wanna know something? Sometime in college, a boulder began to settle squarely upon my shoulders, and it's been gaining weight with each step of the medical education process. I didn't even know it was there until I decided not to return to work and it started gradually melting away. I haven't been this happy, or felt this "light" in years.
However, this new journey, I am finding, is not paved with rose petals and people dancing in the streets...
As a physician who no longer actually practices medicine, I sometimes feel like an exotic animal at the zoo. When I meet other moms and they find out my former occupation, I can see them mentally take one step back and eye me cautiously. "Why in the world would somebody go to school for a zillion years and then quit?" they wonder. And then they take a mental inventory of their own kid: "Is she wearing her sunscreen and sunhat? Do I have her strapped into her stroller the right way?" thinking that I am somehow in a position to judge them on their mothering technique.
News-flash people: I'm still figuring this out just like you are.
After the initial two weeks of congratulatory phone calls and visits to "come and see the baby", I felt like I had dropped off the face of the earth. My friends from residency had already stopped returning my phone calls and emails. They didn't even bother to come to my baby shower. My SAHM friends were busy and distracted with their own older kids. Where did everybody go? Were they disappointed in me? Had I become boring?
I sat at home with my beautiful baby girl and felt sorry for myself for a few weeks. I tried to join a mom/baby group through Craigslist but it fell apart before it even got started. Then I found an exercise group that incorporated your kid, so there is no need to find a sitter. It sounded good because I would already have two things in common with the other women: we were all new moms and we were motivated to exercise. The first few sessions were rough because I was the only one who showed up. "So much for making friends," I thought, but I stuck with it because I felt better just having an excuse to get out of the house. The group grew and I started to meet other moms. After the initial suspicious glances, a few moms realized that I really don't bite and I have gotten to know a few well enough to chat about things other than our kids. Most of these women are former professionals themselves, and so we can relate a bit better about making the transition to SAHM.
I went to a Mom's Night sponsored by this exercise group recently. I actually ironed a dress, blow-dried my hair, AND even put on a little make-up. I felt like I was going on a date or something. I was having a good time, and I finally felt prepared for the inevitable "What did you do before becoming a mom?" questions. I was chatting with a nice group of ladies I hadn't met before and, when asked, gave my standard "I'm a family physician but now I stay at home with my kid". Most people usually make a comment about how useful my education must be, especially those scary nights with a newborn, etc., and I am able to steer the conversation in a new direction. This time, however, this woman just kind of stared at me for a minute and asked, "Why?"
What? What do you mean "why?" Because I was miserable working? Because I wanted to raise my kid, not a nanny? I was caught off guard for a minute, because I didn't really want to come across as a bitter, miserable physician with issues, so I just replied, "I guess I'm just too infatuated with my kid" and tried to laugh it off. Change the subject. Enough about me.
Well. Turns out she's a physician with three kids who works part-time. She then proceeded to tell a long, drawn-out story about her own mother, and how said mother was a professor in the 1950s AND managed to raise a large family and what a great example she had been. This other physician went on to say that she hoped she was going to be setting the same kind of example for her own daughters. I smiled and nodded and asked a few questions. (See, Active Listening. I learned something in med school...) And then I managed to find some other people to talk to.
On the drive home, I felt...deflated. I had been SO looking forward to this chance to go out, dress up a bit, and meet other mommies. I reviewed the entire conversation with the other physician in my head over and over again. Had I made her feel defensive? Did she feel that she had to imply that I am not setting a good example for MY daughter in a sort of retaliation? Was I reading too much into this whole encounter? Why did I care what she thought anyway?
Truth is, I DO worry about what my kids will think when they find out that mommy used to be a doctor. I know that I'm lucky in that I actually CAN make this choice, especially when so many other women physicians out there are feeling trapped by loan-debt and being the sole breadwinner for their families. But will my kids see it as a loving and empowering choice I made for them, or simply view me as a "quitter". I am trying to come to terms with the fact that this issue is probably always going to stay with me.
I am also coming to terms with how difficult it is to make friends when you are not working or going to school. I'm not sure if I will ever truly fit in with the other SAHMs, but I'll keep trying.
When I began to seriously consider not returning to work, I worried that I was giving up the medical profession based upon my first (crappy) job fresh out of residency. I was so discouraged, because I had been desperately clinging to the hope that life would improve after FINALLY finishing the medical education process. This job really seemed to be exactly what I had been looking for, and I was the envy of all of my resident partners.
It quickly became very clear to me, however, that I was not a good match for this clinic or my jobshare partner. I felt like I had been sold a beautiful house that happened to lie upon a sinkhole, and as soon as I had moved into it, it all went crashing into the mud. I used to get horribly depressed before my call weekends, and I had my very first anxiety attack while driving to work one morning. I was so confused and disappointed in myself, because although I did not necessarily sing and skip joyously through residency, it didn't make sense to me that I would have such a problem coping now, AFTER residency, when life is supposed to be so much better. And I was so angry with myself for making such a huge mistake when it came to choosing this job.
After my daughter was born, and I began to contemplate not returning to work, I began to try to separate my feelings about my horrible job, and being an FP. I realized that, for the most part, I really did enjoy taking care of families and doing what I was trained to do. My bitterness was largely as a result of the job. Of course, I still have my gripes about the mountain of paperwork you've got to complete, usually while gulping down your lunch and going through telephone messages in the 15 minutes before the afternoon clinic begins. And I do still have dreams that my pager (that I do not even own anymore) is shrieking and I wake up in the middle of the night clawing at my bedside table.
Unfortunately, I think I have to admit that I was simply naive. I was so driven (and stubborn) and so SURE that medicine was what I wanted. I had several physician mentors during undergrad who were pretty frank with me about the darker side of medicine, and I felt like I was prepared for it. I had bought into this idea that I could, and should want to "do it all".
But nothing and no one can prepare you for how having a family will affect you, because it's different for everyone. I am the last person who would have thought I would be so infatuated with my kid, and so happy and content to watch her roll around on a blanket with her toys. I don't think it was The Job OR The Profession that made me want to leave medicine. It was becoming a mom.
The AAFP taunts me. They keep sending me my AFP journal, where this month I can brush up on Prader-Willi syndrome and skin infections. I feel obligated to keep these journals, because the CME is free and good for a year. Sadly, it's been over a year since I actually completed any CME, but, compulsive person that I am, I have a file drawer containing all of the past year's journals, in chronological order. Twice a month, when the new journal arrives, I recycle the year-old journal, and file the new one in it's proper order.
Medscape is another one. Sometimes I'll get 3 or 4 emails a day encouraging me to complete their free online CME on various topics. I used to save those in a special email folder, but it basically just used up all of my online memory storage and so I deleted that folder a few months ago.
What really gets me are the brochures for conferences in great touristy places like San Diego or Hawaii. I'm not really interested in the latest trends in maternity care or infectious disease, but a sunny vacation sounds GREAT!
Everytime one of these things shows up in my mailbox, I feel this flash of guilt for not being more interested. Sure, I thumb through them, notice the ads for fancy new expensive drugs, maybe even start to read an article. But most of the time, my attention really isn't on it because I'm also thinking about the 500 other things I'd like to accomplish when I've got a quiet moment to myself.
And it's not that I don't read, because my bedside table is currently crammed with books on baby sign language, baby sleep patterns, and coping with toddlerhood (hey, it never hurts to plan ahead...) I guess my focus has shifted and the subject matter reflects that.
Back when I was still trying to decide if I wanted to go back to work or not, I called my state's BME as was told that after a year of having an inactive license, if I wanted to go back to work I would have to take a test (it sounded similar to Step 3 of the USMLE) and go before the board, where they would probably decide that I needed to go back to a "mini-residency" because I only worked for 1 year after residency.
The thought of returning to practice terrifies me, because I know that new tests, drugs, and recommendations have come out just in the nine months since I quit my job. I can't even imagine what it will be like in 5 years when my kid starts school. At this point, I really can't see myself even wanting to try and return to medical practice. But then again, 5 years ago I was an intern and fully concentrating on completing my medical education. Who knows what my life will be like 5 years from now?
Sometimes I think I keep the journals because I'm hoping that my disinterest is some sort of cosmic sign that I made the right choice to leave medicine (and not that I'm an exhausted SAHM to an infant, and I want to spend my free time reading about topics pertinent to my new life...) And then I remind myself that I don't believe in cosmic signs.