Perhaps I was naive, but this was not a consideration when I was making this decision. I chose pediatrics because the children flocked to me naturally and I to them. In fact, pediatrics is a most inconvenient field. Most pediatricians are frequently on call (why in God's name are children always sick at night??) and most of the time we spend with families is non-reimbursable, meaning I will be paying off student loans well into "retirement." Nonetheless, I picked pediatrics because kids are cute and fun to talk to and examine. Adults are stinky and hairy. Also, it's hard to get upset with a toddler for not wanting to take his medications. A little easier to be upset that the adult with smoking-induced lung disease refuses to stop smoking. Lastly, children generally have much more interesting problems then heart disease and type II diabetes - 99.9% of medical problems in adults in the US (don't quote me on that).
My job is additionally unique in that much of it takes place in a hospital. I get to spend time in the inpatient pediatric unit or in the ER. And the students pose the inevitable question, "How do you balance your career with your husband's job and with your kids?" It comes up because during our time together, many of them witness the hoops that require jumping. There are frequently times when there is no flexibility in what we have to do.
One example is that of the little two year old that needs a scan of her abdomen. There seems to be a mass in there. I look at my watch. It is Tuesday and it is 4 o'clock. My one day a week for pick up (because we have an awesome sitter that does it three days and my hubs has Fridays). I should be getting ready to leave to pick up my own three year old before her after care closes at 5pm. My husband's one day a week for afternoon clinic, which usually runs well after 5pm, is Tuesdays, which is why it is my pick up day. Again, this little girl is only two and holding still for even 10 seconds is a feat. So, she has to be sedated. There is no question. The child needs the CT scan. The sedation has to be explained to the family. The medications prepared. The monitors set up. This can not be rushed. It has to be done carefully, exactly, safely, like there is nothing else in the world except this little two year old girl.
What to do? I can't leave this baby girl, with a questionable mass in her belly, she and her parents needing an answer. And I can't expect my daughter's after care staff to sit there endlessly. They have families of their own to get to. Some, with children they need to pick up.
And here, in the chaos, is a great teaching opportunity. The medicine stuff is easy : During this ten second scan we need to address the risks of sedating a two year old, which medications to use, what side effects they have, what the complications can be, how to prepare to deal with them, and how we will discuss the results of the scan.
Then the challenge : Learn to ignore the feeling of abandoning your own child for the time being, to be with someone else's at a critical time in their life. This part, has always been a work in progress. But within seconds it is understood what this could mean for this family. Very quickly the fulfillment from helping this child overrides any scheduling snafu's.
I pick up the phone with panic. "Honey, how's clinic?" "It's fine, actually. I'm almost done. Why?" He knows. "I won't get out of here for at least another hour. An emergency came up." "Okay. I can get the girls."
Thank God, that time. But frequently, that is not the case. Frequently, his clinic is not almost done. So, what happens then? Miracles, people. Miracles.
"What would you do if your husband couldn't help? Do you have back up?" the student asks, a truly worried look on her face. Pray, I think to myself, or screw the child care in a worst case scenario. Leave my child feeling like I forgot about her and hope she forgives me later. I avoid the question for the time to get to work.
Interestingly, everyone asks about the back up. It would be so great if there was an "on-call" baby-sitter. But there isn't. I have yet to be lucky enough to run into that person who will drop everything to pick up my kids for me. Emergencies are pretty damn inconvenient. Hopefully, the neurosurgeons that were taking care of Isabel in the ER, back when the table fell on her face in January, had back up child care so they did not have this problem of their personal concerns interfering with the care of my baby.
The next day, the topic came up again. "So, how do you deal with all this?" (Asking about the balance of family & work).
"If you have children, there will be unexpected illness, snow days, unavoidable emergencies- in any job. My husband and I are willing to accept the occasional scramble for jobs we love. Our standards at home for neatness, organization, what food qualifies as healthy, etc are very different then when we started out. And we spend more income then we'd like on help. But, it is all temporary. They are not little forever. But your marriage to medicine is."
We need to talk this because what is happening is that some women are making choices considering work hours and pay over passion for the art of medicine. They have come so far, invested tons of both time and money, and then, settle. Career fulfillment is integral to the quality of care you will deliver. What is happening is these women are giving up before they start. Like Sheryl Sandberg states in her book, "Lean in!!!" The other stuff will work out but, as I learned the long way, inherent happiness in following your calling is not negotiable.