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FP to SAHM-Reflections on Leaving Medicine

14 years 5 months ago #70530 by TBird

When they find out I'm not returning to work, one of the most common reactions I get from physician friends is "Oh my gosh, I could never stay at home. I'd be SO BORED!" This used to really irritate me, because it seemed to imply that the only really INTERESTING thing about us is that we're physicians. I mean, what's so interesting about SAHMs anyway? We just sit at home and stare at the wall all day, right?

In fact, I can't remember the last time I was bored. (But if I had to take a guess it would probably be sitting through yet another highly stimulating coding and billing lecture post call during residency...) In addition to my roles as housekeeper, child care provider, and CFO of the household, I'm one of those irritating artsy-craftsy types who has at least three projects going at any one time. We go to my mom's exercise group every day, and I am amazed at how much time I can spend playing with and observing my kid. Maybe I'm just easily entertained.

It took me awhile to realize that sometimes people feel threatened by my decision to stay home, and that the whole "I'd be so bored" response is really more of a defensive reaction than anything else. Now, instead of getting ticked off, I just smile and reply that somehow I manage to fill up my time.

In fact, my kidlet is asleep and I've got things to do... What am I doing sitting in front of a computer? :)

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14 years 5 months ago #70531 by TBird

Like most parents, mine almost burst their buttons with pride the day I graduated from med school. To say that I did not grow up in a household that was overflowing with hugs and emotion is an understatement, but I could tell that it was truly a great day for them. And now that I am a parent (and practically jump up and down like a cheerleader anytime my kid meets a milestone), I can understand how having a kid get through med school can make parents feel like "hey, we must have done SOMETHING right!"

Growing up, my parents always had very high expectations and very strict rules. One of those expectations was that you don't just quit something that you have committed to do. I struggled with the decision not to go back to work, and I felt like the ultimate quitter. All I needed was a big scarlet Q. My parents' reaction to my decision not to return to medicine was the one I was the most concerned about.

It wasn't like they didn't know I was miserable. We went out to dinner about 6 months into The Job From Hell, and my dad asked me how things were going at work. I was so worn out and emotionally fragile, that I just burst into tears right in the middle of the restaurant. They were completely stunned. I don't think they'd seen me cry since I was sixteen and in the middle of some sort of teenage angst-driven fit. They kind of stammered for a minute, and then my mom changed the subject while I collected myself. She sent me an email the next day saying that she was sorry to see me so unhappy.

A few weeks later, my brother was in an accident and almost died. He has totally recovered now, but the way my parents relate to my brother and I definitely changed.

After my daughter was born, and I had decided not to return to work, we had my parents over for dinner. I guess part of me will always be an eight-year-old girl who wants to please her parents, and I spent some time trying to figure out how to tell them. I had built it up in my mind as the final obstacle to becoming a SAHM. We were playing cards, and after I told them, my dad says, "Well, we're proud of you whatever you do." And my mom says "Honestly honey, we haven't seen you this happy in years." And then she finished dealing.

All that wasted time worrying.

What makes me sad is that I cannot count how many of my friends and relatives have commented on how happy and relaxed I seem now. It makes me wonder just what kind of a miserable, depressed zombie I must have appeared to be these last several years without even realizing it. And it makes me glad that we all have choices in this life. After years of choosing education and ambition and career, I think I may have finally struck gold. I'm choosing family.

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14 years 5 months ago #70532 by TBird

Throughout the last trimester of my pregnancy, I was obsessed with the thought that I was going to have a prolapsed cord. Don't ask me why, because I've never even seen one, but all of my physician friends had had complications with their pregnancies, and I was convinced that MY complication was going to cause me to end up calling 911 with my rear in the air as soon as my water broke.

The fact that I had a pretty textbook labor and delivery just caused my fears to be transferred onto my new baby daughter. I had done so many "Fever r/o Sepsis" admits on newborns, and I really just couldn't bear the thought of putting my own baby through the workup. My family was very tolerant of my obsession with hand-washing, and again, we sailed through the newborn period without a problem.

Nobody ever said that fears had to be rational.

So when I went to change my daughter's diaper a few weeks ago and there was blood in the stool, my first thought was, "Calm down! She's too happy to be having an intussusception." She had been rolling around on her blankie, waving her toy around and laughing. But I looked, and I couldn't see a fissure. And because these things never happen during office hours, and we have no urgent care around here, my dilemma was whether to go to the ER or wait until the next morning to have her seen by our doctor.

The rational, medically educated side of me kept thinking, "She doesn't belong in the ER. She's looks too good. I'll just be wasting their time." While the doubt-filled, mommy side of me was saying, "You idiot! Do you really think you can be objective about your own kid? What would you tell a parent who called you with this? How will you feel if she ends up crashing in the middle of the night? Get over yourself!"

While I was having this mental debate, my daughter made the decision for me by having another bloody stool. We packed her up, and headed to the ER at the children's hospital, where she was the happiest, healthiest looking kid in the place. I have a "Don't ask, don't tell" policy about being a physician, but I must have said something during her exam that gave me away. The peds ER doc asked if I had a medical background, and my husband quickly responded that I was a family physician. Sheepishly, I said, "I know we don't belong here, but I'm really trying hard not to be my own kid's doctor." He was great about it, and replied, "Hey, I'm totally with you. I don't even look in my own kids' ears." Long story short, she ended up having an anal fissure that required a little more intensive search and instrumentation to find.

Most people would not think twice about having their infant evaluated in the ER for bloody stools. Ironically, it was my medical education that caused me to doubt myself. And, unfortunately, I'm pretty sure it won't be the last time.

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14 years 4 months ago #70533 by TBird

Like most FP residency programs, our patient base was primarily underserved and seething with morbidity. I remember at the end of our intern year, we joked that we could deal with anything that could be described in initials: DKA, OD, AMI, CHF, PE. Our time in clinic was largely spent trying to keep people stable and out of the hospital.

We did have some relatively young, healthy people and families with whom we were able to get experience with preventive medicine. Unfortunately, many times their resources were so stretched that our visits were spent trying to help them understand how to properly feed their kids and keep them safe. Having time leftover to discuss behavior and learning and sleep issues seemed like a luxury.

My first job out of residency was in an affluent little suburb, and the patients were well-educated and had few chronic conditions. I mostly saw young women and kids, and I felt like I had landed on the moon. Who WERE these people who dragged their kids in for every little sniffle? Who wanted prescription acne medicine without ever having tried anything over-the-counter? Who were upset because their new oral contraceptive gave them a light period that lasted five days instead of three? One day, I had FIVE (I am not kidding!) FIVE perimenopausal women scheduled in one day to "discuss hormones" and weep. I seriously wanted to run into the waiting room and start hollering "Anybody here have Diabetes? How about some high blood pressure? Hey! You in the back with the walker and the portable oxygen machine! Come on down!"

And you can bet these patients had questions about their kids. Most of the time, they were the usual "when to start solids/potty-training/learning the alphabet" type, and I got good at digging deep into the memory banks for the required reading I had done during residency. Unfortunately, my advice was mostly "theoretical" and usually came from a textbook, journal article, or colleague, as opposed to "practical". I was a childless female physician. I had had nothing to "practice" on yet!

When I became pregnant, and subsequently quit my job, I wanted to use the time to read. Instead of textbooks, however, I decided that I was going to read the books that my patients had been reading and asked me about, but I had never had time read for myself. Of course, I started with "What To Expect When You're Expecting", but then I moved on to "The Girlfriend's Guide" and Jenny McCarthy's "Belly Laughs". One book I truly wish I had read while still in practice is "The Happiest Baby on the Block". It is incredibly well-written and if I were still in practice, I would give it out to every family with a newborn. It would have saved me alot of home calls. Seriously. I have books on baby sleep patterns and baby sign language, and have recently started reading about toddlers.

Can I get CME for this?

My bookcase looks like the "childcare" section at Barnes and Noble. As I was straightening it up the other day, I felt a stab of empathy for my former patients. I think that, were I still in practice now after having my kidlet, I would probably still be giving the same advice, but I would probably be able to deliver it in a more specific and user-friendly manner. I sometimes wish that I could go back in time with the experience I have now, and do a little better job for those patients.

Hopefully, it will be a few more years before I have to invest in the menopausal books...

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14 years 4 months ago #70534 by TBird

I ran into one of my former attendings from residency a few weeks ago. This is a woman who works part-time and has a small child, and who I used to think of as a role model for myself when I became a mom. I also thought of her as a friend. After I graduated from the program, we still used to have lunch or see a movie, until something changed and she stopped returning my calls.

The last time I saw her was at a lunch with some of my former resident partners. I was in my third trimester, had just quit my job, and was having a great time. She was excited for the baby, and wanted to go with me to the baby store and register. But then, she didn't return my calls. Or my emails. She didn't come to my baby shower, and after my daughter was born, she didn't call or even bother to send a card.

I spent alot of time trying to figure out what had happened. It wasn't like we had had a disagreement. I told myself that she was too busy, or possibly disappointed in me for not returning to work, or that maybe all that we had had in common was that we had worked together. This was a woman that I had admired and respected, and I grieved for the loss of this friendship. It was especially hard because I couldn't even pinpoint what had gone wrong. Eventually, I decided that I was wasting way too much mental energy on someone who obviously didn't want to be a part of my life anymore. Sometimes people just fade away.

Until you turn a corner and BAM! almost run into them with your kid in the stroller...

We made small talk as she admired my baby, and I felt horribly uncomfortable. What do you say when so many months have passed? She told me that her own child had been very sick and in the hospital recently, and though her daughter was now recovered, she still had nightmares about her hospital experience. Then this woman said, "I don't think I'm handling it very well," burst into tears, and started walking away.

I felt like one of those cartoons where their eyes bug out and their jaw drops to the ground, meanwhile their feet are encased in concrete.

I caught up to her where she gave me a hug and said "I'm so proud of you for staying home. Your baby is obviously so happy..." And then she kind of gathered herself together and said, "see you" and left. I stood there and sputtered for a minute, and then just...headed home.

What had just happened here?

My husband thinks that my own decision to stay home made her feel guilty for not staying home with her own kid, and so she started avoiding me. Unfortunately, I think he may be right.

I thought that I had weighed all of the pros and cons of leaving medicine and staying home with my baby. Unintentionally inspiring guilt in former friends was apparently one that I had forgotten to add to the list. I cannot hold myself responsible for her feelings of guilt, but I still feel sad to have lost her as a friend and role model.

Pedestals make a big mess when they fall to the ground.

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14 years 3 months ago #70535 by TBird

A little while ago, my husband sent me to the day spa for my birthday, and on the door as I entered the place was a polite little sign asking everyone to "please silence your cell phones and pagers in order to maintain the serenity of our spa". Now, I've seen these signs before, but this time it just really hit me; THIS was a PAGER-FREE workplace! What would it be like to be able to live and work without a little black box attached to your hip that always manages to scream at you during the worst possible time?

I did not always loathe my pager. In residency, we all had personal pagers, and then we had the admitting pager that the on-call senior carried. The admitting pager was often referred to as the "hot potato" because it was our tether to the ER and a never-ending supply of admissions. I used to fantasize that the ER docs had surreptitiously placed a small camera inside of it, and stood around a monitor waiting for us to get through the cafeteria line and finally sit down to dinner. "Page 'em! They're eating!" they would call out to each other and BAM! we'd have three admits. But at least the next morning you could pass that pager off to the next sucker on the schedule and leave rounds wearing only your personal pager and feeling a hundred pounds lighter. Or maybe that was just the post-call delirium setting in.

Once I got out into practice, my pager became the symbol of my growing resentment. I hated that my time was never really MY time. I had to start carrying my "hospital bag" in the trunk of my car, and my husband and I often drove separately to dinner or other functions "just in case" the damn thing went off and I had to go into the hospital. On our anniversary, I had to sign out to one of my partners so that we could try to have uninterrupted dinner, but it made me feel like I was asking permission to have a life. And I just became more resentful.

I will never forget that feeling of nausea and rage and sadness that would come over me all at once when the pager would go off and I would see the number for the hospital. On TV sometimes, a pager will go off that has the exact same ring that mine had, and I still get a 10 second blast of adrenaline and palpitations and anxiety before my body's ingrained response catches up with my rational mind. I hate that years of carrying a pager has made me an equivalent to one of Pavlov's dogs.

On my last day of work, I created a satifying little pile on my desk of my work laptop and accessories, my office keys, the cell phone and my pager. I remember turning off the pager, and feeling a sense of finality. As if I was being set free to start a new life.

I am. And it is without a pager.

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