People have asked me how I have been able to go through medical school and residency and have young children, and I had always responded by downplaying how hard it is, both to myself as well as to others. About 90% of the time, I feel it is not just manageable, but very enjoyable. I feel very blessed to have the life I have. It's during the other 10% when things don't quite line up, when I feel the pressure of a demanding home life, as well as a demanding career. This past month falls into that 10%.
I am on my cardiothoracic anesthesia rotation - the first of 3 months. It is an intense month during which I provide anesthesia for patients undergoing heart surgery, lung surgery, and major vascular surgery (aorta, carotids, etc.). The patients are usually pretty unhealthy, and many have to go onto cardiopulmonary bypass (CPB) so that surgery can be done on their heart. Coming "off pump," or weaning off CPB is probably the most intense part of the anesthetic management, during which the heart needs to be re-started (previously stopped so that the surgeons can operate on it), and the resulting blood pressure (generated from the now revived heart) needs to be high enough to provide blood (and thus oxygen and nutrients) to the rest of the body, in particular the brain and the heart itself. If it is not high enough, the perfusionist, anesthesiologist, and surgeon work together to get the pressure higher, but not so high as to damage the newly reconstructed heart. We can give medications to raise the blood pressure; we give fluids or transfuse blood products; we shock the heart. Sometimes it goes smoothly, sometimes it does not. Either way, it is high intensity. This intensity pervades the atmosphere of the operating room all day, everyday. My attendings are all very good anesthesiologists, very good teachers, and very reasonable to get along with. But they are also very hard workers, and expect the same of us residents. 12 and 14- hour days hadn't been too bad on other rotations, but on this rotation, they are pretty brutal. That does not even include the extra on-call nights I have. I am physically and mentally exhausted by the time I leave. When I get home I have a whole new set of demands placed on me.
Up until now, coming home to my kids was the highlight of my work day. My drive home was my transition from hospital mode to home mode. The work day just melted away with each passing mile in the car until I got home. I was excited to walk in the door and have the kids exclaim, "Mommy is home!" and come running into my arms. But this month has drained me so much, that I haven't even had the energy to enjoy my kids. I take care of them, but afterward, I fall asleep on the floor or the couch without enough energy to play. I have less patience for their sibling squabbles or their individual demands of, " May I have more milk, please?" or "I don't wanna take a bath!" or "I don't wanna go to bed!" And while I have snapped at them more frequently this month, I have, for the most part, internalized most of my stress. That is, until yesterday.
I was post-call yesterday. The week leading up to this call was a very tiring one. My parents watched the kids, while I was on call, and my husband was out of town. When I got home after call, the kids were particularly demanding. Between being home for the week (Spring Break) and having my parents jump at their every demand, the kids had been accustomed to getting what they wanted when they wanted. This is not usually the case, so I wasn't willing to give in. So the kids' whining escalated and escalated, and I finally blew up. I went into my closet and started repeatedly banging my purse against the shelves. I cried and cried like a baby. My father wanted to sit me down and "talk" to me, but I snapped back and told him I wasn't going to listen (I don't usually talk to my father this way). I mean, really, I did NOT need yet another person criticizing me (like at work), and making demands of me. That was the whole problem! I felt as if my life was not my own. I go to work, and demands are made of me; I go home, and demands are made of me. I have to scrounge for time to meet my basic needs of eating, sleeping, and going to the bathroom. How many times have I been in the bathroom, and the kids are asking for something, or my pager is going off???? Whatever I do is not good enough. Rarely, do I hear, "Good job, " or even, "Please, " or "Thank you." After a while, it gets tiresome.
So my parents took the kids to the library, and I fell asleep. Finally. Sleep deprivation can do quite a number on one's emotions, especially to those of us who are already emotional. I woke up, and immediately regretted my emotional outburst. My parents called from the road, and offered to bring dinner home. I agreed and a little while later, they all came home. My kids ran in the door, and I greeted them with great big hugs. The rest of evening was pretty uneventful. We all had dinner and played bingo. I thanked my parents for taking the kids out, but nothing else was said about my emotional outburst. I cuddled the kids to bed and we all fell asleep.
My parents have left, and I am alone with the kids for the day. My husband returns later today. I have caught up with my sleep, and feel pretty back to normal. The kids and I had a nice, quiet morning, have fun plans for this afternoon; they are currently napping, so that I can even blog.
So what do I make of all this? And why have I decided to post about this? As I started off above, people often ask how I do it. And as you can now see, this is how I do it. 90% of the time, I have my sh*t together. My husband and I work as a team, with the support of our family and close friends. My husband and I have strict schedules. We work when we work, and we play when we play. Work time does not encroach upon play time, nor vice verse. My husband and I are in this together; our priorities are our children; when either of our jobs become more demanding, the other makes sure to cover and be there for the family. Our designated family time is sacred, but we have to be flexible as far as when to designate when family time is from week to week. My husband and I have each sacrificed personal hobbies and alone time (more on this later). I can't say enough about my husband, who probably deserves his own post praising how wonderful of a father and husband he is. He is the reason this works. He is the reason I feel comfortable going to work. He has gone through medical school and residency with me.
So now onto the other 10% . . . this is how I do this . . . Now, I'm not saying that this is the right way to go about things; I'm just saying this is how I have dealt with it. I often internalize my stress. Always, I talk to my husband. Sometimes, I talk to my family, I talk to my fellow residents, I blog. But for the most part, particularly at work, I suck it up, and internalize my frustrations. It's not as if I can have a heart to heart with my attending, or the surgeon, or the nurses. As a resident, I am there to make their jobs easier. So I internalize. At home, I vent to my husband. I talk to my children, but their ability to grasp things is limited. And likewise, my role at home is to meet their needs. So, again, I find myself internalizing. This month, the pressure just kept building up without a break until I finally blew up. What have I learned? Prophylaxis. I want to take care of things long before another explosion happens; do something about it beforehand. You know, like take some time out for myself? Completely foreign concept to me right now, but something that I will be come re-acquainted with soon. As I mentioned above, my husband and I have both sacrificed personal, as well as couple time. It is probably time to reclaim some of that back.
For anyone out there thinking about medical school and residency and family, I say it is do-able. Here, I present some of the ugly side, but it not always like this. There is no "ideal" time to have children, since every period of training has its pluses and minuses. I, for one, think that being pregnant during medical school was the ideal way to go for us. But for others, it is not the right time. Regardless of one's choice, just be prepared for the tough times because they will most likely come. It's just how we face them that matters in the long run. I am fortunate to have a very supportive husband. Moreover, we have very supportive families, as well as friends. I am aware that I have chosen to have children and have a career outside the home. I am grateful that I am able to fulfil this choice. I see my life as a blessing, and try to remind myself that I have chosen this life (along with the will of my higher power). If at any point, I do not like my life, I have the power to change it (along with my higher power:).
And with that, I leave thee with the following (not personally taken from Alcoholics Anonymous):
