A Vulnerable Place
By Katrina Mitchell, M.D.
Popular television shows like Scrubs and Grey's Anatomy portray physicians as leading hectic lives filled with answering pagers and socializing. But balancing work and personal life for real physicians and researchers is far more complicated than the picture painted by sitcoms. A doctor's life is certainly hectic. But for physicians who have children, the problem is not sharing the demands of medicine with a desire to party or play. It's finding a day-care arrangement that suits a resident's around-the-clock schedule. It's finding the emotional energy, after meeting patients' needs all day, to meet your kids' needs in the evening. It's finding the will not to fall asleep when you haven't seen your baby in 24 hours but you just got off call.
Those are concerns for male and female physicians alike. And they're intensified in families where both Mom and Dad are doctors. At the same time, working parents outside of medicine—who know how hard it can be to juggle kids with a 9-to-5 schedule—wonder how physicians do it, particularly in light of changes in medical reimbursements that have made for more paperwork, longer days, and shorter appointments with patients. An article last year in U.S. News & World Report highlighted the challenges. Among trends the article pointed to was the fact that fewer medical students are choosing specialties with the most demanding schedules, as well as the fact that in order to balance home life and work life, young physicians generally tend to work fewer hours than was the norm several decades ago. The article also acknowledged that parents in medicine need good organizational skills and a good sense of humor in order to uphold both their professional and their parental obligations.
To illuminate the highs (and lows) of being a parent and having a career in medicine, an assortment of clinicians and researchers with Dartmouth ties offered insight into balancing those dual roles. They included recent and not-so-recent DMS alumni, faculty, and retired faculty. Their children range in age from barely 43 days to nearly 43 years. They had their children before, during, and after medical school. Some of the grown children have gone into medicine, and some have not. Their memories of parenting are humorous, poignant, and matter-of-fact. This is what they had to say . . .
And baby makes four
Drs. Paul and Angela Sanchez
Sophie, born October 2000
Isabella, born August 2006
Paul Sanchez, DMS '03, and Angela Sanchez, DMS '04, met as undergraduates at the University of New Mexico, were married, and moved to the Upper Valley when Paul was accepted to Dartmouth Medical School. Angela entered DMS the following year. Their older daughter, Sophie, was born when Angela was a secondyear student. At the time the interview below was conducted, they were expecting their second child, and Isabella was born in early August. Paul is now a fourth-year resident in ophthalmology at the University of Texas Southwestern Medical Center in Dallas, while Angela is in her third year in Baylor's Family Medicine Residency in Garland, Tex.—and is serving as the program's chief resident this year. They plan to head home to New Mexico when they are finished with their training.
Why did you choose to have children while you
were still in medical school?
Paul: We always wanted to have kids and
were excited about being parents.
Angela: Sophie was not planned but not
prevented either. We came to the realization
that there is never a right time
to have kids. We figured we would just
see what happened.
How did you manage a new baby while you
were both students?
Angela: It definitely was hard. We had no
help. No family. No money. It was just
Paul and Sophie and me. Day care in
the Upper Valley was particularly difficult.
From the beginning, it was all
about balance.
Paul: It also was tough because with Sophie
we were doing it for the first time.
And while Angie was pregnant she was
taking embryology, so it was very scary
learning about all the things that can go
wrong with a baby. The little that we
did know was enough to make us very
scared. Also, we just didn't have any
backup. For family to come here, it was
a major expense and a full day of traveling.
It was those types of burdens—feeling like, "Game on, it's just you and
me"— that were the hardest. Other
medical students who had kids had had
them for several years, and their kids
were older. We didn't have anyone to
relate to at that point. Even the twodoctor
families we had as attendings
hadn't had their kids while they were
still in medical school.
So what were some of your Upper Valley
day-care misadventures?
Angela: Students didn't have access to
the Dartmouth or DHMC employee
day-care centers. So we found a babysitter
who went to our church. She was a
young mother who was starting a new
day-care business in her home. She was
very organized and had spreadsheets
about what time she would feed and
change the kids. We felt very comfortable
with her. But then one afternoon I
went to pick up Sophie, and another
baby Sophie's age was in a stroller sitting
in front of the house, which was on a
busy street in Lebanon. I said, "What is
going on?!" And she said, "Well, she fell
asleep and I didn't want to wake her
up." I said, "We're withdrawing today.
We'll just see you in church." We finally
found good day care when Sophie was
six or eight months old.
And you're pregnant again—how is it different
being pregnant as a resident compared to as a
medical student?
Angela: As a resident, people totally rely
on me. I just got appointed to a chief
resident position, with more duties on
top of what I already have. And it's sick
people relying on you, so you have to
sacrifice yourself.
Looking back on your experiences so far, what
has been the most significant or surprising
thing about parenthood?
Angela: People always talk about balance,
but it's more than that. It's also a series
of sacrifices. Sometimes Sophie is the
one who sacrifices. Sometimes it's her
time with one parent or another. Sometimes
it's the house that suffers. Sometimes
it's personal time. Sometimes it's
work. It's very, very difficult to do all
those things well, so you figure out what
you have to sacrifice that day.
Books and triathlons
Drs. Jennifer Shu and Alex Kallen
Jackson, born February 2001
At the time the interview below was conducted, Jennifer Shu was an instructor in pediatrics at DHMC and Alex Kallen, an infectious disease specialist, was completing his M.P.H. and a fellowship in outcomes research at Dartmouth's Center for the Evaluative Clinical Sciences. After Kallen's graduation, they moved to Atlanta, where he is working in the Epidemic Intelligence Service at the Centers for Disease Control and Prevention. Shu—who is also the coauthor of Heading Home with Your Newborn: From Birth to Reality (American Academy of Pediatrics, 2005) and the editor of American Academy of Pediatrics: Baby and Child Health (DK Publishing 2004)—is currently working on another book about parenting.
What is it like being both a parent and a
pediatrician, Jennifer? Does that make it
easier to relate to patients' concerns?
Jennifer: I am constantly learning on a
daily basis on both ends—learning
things at home that help me better advise
my patients and vice versa. It absolutely
makes it easier to relate to my
patients' concerns to be a parent myself.
I try not to over share and do so only if
it seems relevant. But sometimes just
knowing that physicians deal with problems,
too, helps patients not to feel so
alone in their concerns.
How did you get into writing?
Jennifer: I've always been interested in
talking to as many people as possible.
Working one-on-one with patients is
great. But giving classes or having group
meetings with patients allows you to
reach more people at once. And with a
book you reach even more. I took a couple
of years off after we had our son. We
were in Denver, and someone I had
trained with in San Francisco was there,
too. We looked at the parenting literature
and saw a lot of books for medical
audiences by doctors and a lot of readable
books by nondoctors. We wanted to
come up with a user-friendly book on
parenting that was also really sound.
I understand you do Ironman triathlons, Alex.
How do you find the time to train? And do you
ever train with your son?
Alex: I get up very early in the morning.
I'm lucky to have a wife who helps with
child care, because training for an Ironman
is like another job. At peak, it can
be 25 hours a week. My son likes to ride
his bike and loves to run on the track
over at Lebanon High School.
Jennifer: It would slow Alex down too
much to take him on Ironman training.
Alex: He would get bored!
What is your favorite memory of being a
parent and a physician?
Alex: I'm not sure if it's my favorite memory,
but it was certainly memorable. I
was working at the University of Colorado.
Jen was having a c-section in the
operating room upstairs, and I was running
up and down from the OR to see
patients in the clinic because my pager
kept going off.
What words of advice do you have for young
M.D.'s planning to have a family?
Alex: It is easy to get caught up in the rat
race of clinic, so it's important to remember
that you have flexibility and
you have a choice as long as you're willing
to make it. It's absolutely key to
make time to spend with your family.
Jennifer: Try to figure out your priorities
for career and family and reassess them
every year or two so you can stay on
track and redirect quickly. Don't stay in
a situation that doesn't create an ideal
balance for you. Staying with the status
quo may be easier, but if your priorities
change once you start your family, make
sure your job responsibilities change as
well. I was really surprised that I wanted
to be with Jackson so much after he was
born. But if you leave practice for any
period, it's important to maintain your
board certification and medical license
so you can return to practice quickly.
Do you feel there's an optimal time for
physicians to have children?
Jennifer: The sooner the better, so you
have longer to enjoy them! But on the
flip side, better late than never. Seriously,
there's no perfect time—so when it
happens, embrace parenthood.
Making choices
Drs. Joyce DeLeo and Mark Splaine
Nicholas, born August 1991
Christian, born September 1993
Joyce DeLeo is a researcher who studies the mechanisms of chronic pain; she is a professor of anesthesiology at DMS and the director of Dartmouth's Neuroscience Center. Mark Splaine, a general internist, is an associate professor of medicine and codirector of the Quality Scholars Program at the Dartmouth-affiliated Veterans Affairs Medical Center in White River Junction, Vt. He is a 1991 graduate of DMS, earned a master's degree from Dartmouth's Center for the Evaluative Clinical Sciences, and did his residency at DHMC. They met 19 years ago in Germany, while DeLeo was doing her doctoral research and Splaine was doing research between college and medical school. DeLeo joined the faculty in 1991, and Splaine in 1996. They have two sons, both born while Splaine was a resident.
With one clinician and one researcher, does
that make it easier or harder to balance family
life than if you were both clinicians?
Joyce: I think being a researcher is easier
in that you can control your calendar
more, and you can control when you are
going to do experiments. You aren't
having to schedule patients at certain
times. You can decide when to write
grants and write papers.
Mark: I especially relied a lot on Joyce
during residency. She has some pretty
funny stories about me coming home after
being on call and trying to be an attentive
father and basically falling
asleep. That was a time when it was particularly
challenging, because early on
we had set out the idea that family was
going to be our first priority. Making
sure that happened during that time as
much as it could set important groundwork
for how we did things later.
What are some of those funny stories about
falling asleep?
Joyce: Mark was an intern when Nick
was an infant. I didn't get to see Mark
much that year, and we lived in Lyme in
a place without many neighbors, so it
could be pretty lonely. Mark would come home and barely talk and fall
asleep. One Saturday, I took Nick and
drove all the way to Canada and back. I
thought that when I got home Mark
would have been worried about where
we were, but he was still sleeping. He
didn't even know we were gone!
What are some of your important family times?
Mark: Dinner is very important in our
family. Also, making time for just the
two of us has been really important.
And it has really been important to plan
ahead and balance both of our careers.
Frequently, one of us is asked to do
something and the other one has to say
no to another opportunity, because
those career choices are never as important
as our family.
Did either of you ever take your kids to work?
Joyce: I never took maternity leave with
either of the boys. I didn't like staying
home, and I had a lab to run and a graduate
student to oversee, so I really
couldn't stay home. I took the boys to
my lab with me when they were babies,
and they still like going in. They might
work in a lab themselves soon.
Mark: It was also fun for me to bring the
boys in for rounds. Patients really enjoy
meeting kids.
Is there anything you've learned that you wish
you'd known when your boys were younger?
Joyce: To relax and laugh more and enjoy
your children to the fullest, especially
when they are young. It is so amazing
how fast time goes by. Don't rush too
much—it is not good for your health or
for your family. Try to do just a little
less, not more—and remember that you
can always say "no." Try to keep dinnertime
sacred by saying no often to work-related
evening activities.
Do you think either of your children will go into
medicine or research?
Mark: I don't think medicine, but both
of them like science, so that may be a
possibility. But we have been very conscious
about letting them do what they
want to do. Chris's current choice is to
be a rock star, a businessman, and then a
scientist. Nick is an excellent writer but
has a strong love for science, too.
Going it alone
Dr. Laurie Draughon
James, born August 1971
Jennifer, born April 1974
When Laurie Draughon, DMS '85, headed east to enter Dartmouth Medical School, she was recently divorced and had two children, then aged 10 and 7. She was one of 26 women in a class of 80 medical students at Dartmouth. After earning her M.D., she returned to her native California to do a residency in internal medicine at the University of California at San Francisco's Kaiser Foundation Hospital. She has been in private practice in California since then—first as part of a group practice and from 1999 to 2005 as a hospitalist. About a year ago, she started her own business as a "house-call doctor," specializing in coordinating the care of homebound patients.
How did you end up in medical school and at
Dartmouth?
Laurie: I had always wanted to be a doctor,
but my dad wouldn't help me with
college. So I married my high school
sweetheart and had my son when I was
18 and my daughter when I was 21.
Then I convinced my husband that if
anything happened to him, I wouldn't
have a way of supporting myself, so we
compromised on my going to nursing
school. I got my associate's degree, and
when I went on for my bachelor's degree
we got divorced.
That's when I just decided to go for it and go to medical school. I wanted to get out of state and see something new. And I wanted to go to a good school and live in a good place for kids. Dartmouth was a great place and turned out to be good for all of us.
How did you manage two kids on your own
during medical school?
Laurie: It was definitely tough at times,
but I have always been pretty good at
working with my environment. That
was helpful because the neighbors
around me were very helpful with
watching the kids. I got them involved
in afternoon sports and evening sports,
too. They were on the swim team my
second year, and they had to practice
every evening until 7:00 p.m. So I
would study before that and then spend
the evenings with them. Then I would
get up at 3:00 a.m. and study while they
were still sleeping. I never got more
than four hours of sleep.
What about when you started clinical rotations
in your third year?
Laurie: My mom came out and watched
the kids during the more difficult rotations
when I was going to be gone. And
I managed to do most of surgery and ob-gyn
in the summer months, when they
could stay with their dad. Even though
first and second years had been rigorous,
I could have a tape recorder in class if I
had to go to a concert for one of the
kids. You have to know how to deal
with what you have.
Also, one thing my kids always knew
was that if they really needed me for
something, they still always were a priority.
They knew they had to be more
independent than other kids their age,
but I was always there if there was some
real crisis. Residency was tough, but
since I did it near home in California, I
had an agreement with their dad that
when I had night call, he would take
them. He helped out a lot.
Would you and your kids choose to do it all
over again if you had the chance?
Laurie: I would do it all over again, and I
think my kids would, too. I would definitely choose Dartmouth again. Even
though the kids thought it was the
longest few years of their life, they look
back and think it was a really great experience.
Both have been very successful
and are just great people.
Were either of your children interested in
going into medicine?
Laurie: Neither of them went into
medicine, because I think they saw what
a hard life it is. They both have been
extremely successful, though. My daughter
is a corporate controller for a software
company. And my son individualizes
computer programs for companies.
He actually got his start doing that way
back in Lyme Center, while I was in
medical school, when he began doing
programs on his Commodore 64.
Back in the day
Drs. Frances and Harold Friedman
Katherine, born November 1963
Elizabeth, born May 1966
Theodore, born January 1968
Frances and Harold Friedman, who retired in 2003 after more than 30 years on the Dartmouth faculty, were both allergists; he was also longtime chair of the DMS Admissions Committee and is still a member of the committee. Both were themselves the children of physicians; her father was a general practitioner and his was a radiologist. And two of their three children have gone into medicine as well. Beth, their second daughter, a 1997 graduate of Dartmouth Medical School, is now an allergist herself in Rochester, N.Y., while their son, Ted, is a fourth-year resident in pathology at Emory University. Fran and Hal Friedman met when they were both residents in internal medicine at the University of Michigan. They had their first child during Fran's second year of residency, their second when Hal was in the public health service after he finished residency, and their third after Fran had finished her residency.
How did you manage a romance in the midst of
the rigors of residency?
Frances: We started dating in March, because
I remember he took me out to
dinner for my birthday in April. He proposed
in August and we were married in
December.
Harold: And she was pregnant by
February.
Frances: We didn't mess around! I had
my first child during residency, in my
second year—and they didn't have maternity
leave then. I had to go tell the
chief of service that I had to change my
vacation time from June to November.
We were looking at the board where our
schedules were lined up, and he said,
"This schedule is etched in stone." And
then he said, "Why do you need to
change your vacation time?" And I said,
"I'm going to have a baby in November."
He puffed away on his pipe and
said, "Let me think about this." He did
end up changing both my and Hal's vacation
time. I had the baby November
10 and went back to work December 1.
How did you manage having children during
residency?
Frances: I think residency these days is
much more stressful. We didn't have the
acuity of patients in the hospital that
residents have today. We were on call
more, but we weren't getting two or
three patients every night who were at
death's door.
Harold: We were worked hard, though.
And in some ways, it was harder because
we didn't have the support system that
residents have today. We didn't have
day care at the hospital, for example.
You had to have someone in your home
or have a private babysitter.
Did you ever encourage—or discourage—your
children from entering medicine?
Harold: No. The two who went into
medicine both entered it fairly late.
Beth worked for publishers after college
at Haverford but realized that liking literature
and selling books were different
things. She was four years out of college
before she went to Harvard Extension
School to do her premed requirements.
Ted had been an economics major with
a Japanese minor and had a master's degree
in Japanese. He was 28 when he decided
to go to medical school and did
his premeds at Penn.
How was it having children and practicing when
women weren't as well represented in medicine
as they are today?
Frances: I never had the awful tales to tell
about being discriminated against. But
when I applied to medical school at the
University of Michigan, they always accepted
200 men. And then there were
spots for a few women—there were 12
women in my class.
Harold: There were 125 men and three
women in my class at the University of
Pennsylvania.
Did you have any particular strategy for managing
it all?
Frances: I had to institute a "parent of the
week" system so that I didn't always
have to be the one to make sure they
did their chores and homework or whatever.
One night, Hal was upset that the
kids weren't in bed. I said, "Aren't you 'parent of the week' this week?"
Mitchell, a 2006 graduate of DMS and a former member of the Dartmouth Medicine Editorial Board, has written many articles for the magazine—including features on the Patient Partnership elective and on health-policy talks at DHMC by the 2004 presidential candidates. She is now a resident in surgery at Cornell's New York Presbyterian Hospital in New York City. She conducted the interviews from which the Q&As on the following pages were adapted this past spring, just before her graduation.
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