when to have a baby

Ok...so I remember that when DH was in med school he worked w/ an IM resident whose 3rd yr ortho resident wife was pg. This is what I remember -- she was getting *really* uncomfortable from all the standing (and that was way before 9 months). And his mom was going to live in their house with them to help with the baby.
I never heard how it all worked out. I think his mom's involvement was key but it would still be really, really difficult.

[houseelf]

O.K. Truth time here. This is the type of post that invokes so much personal passion that I usually log off and think about a response before typing away.

In this case, however, I have a strong visceral response that will be lost if I try to come back later in an attept to craft a more P.C. response.

In order to lend more credibilty to what I say, I feel compelled to give you a little background. I am a lawyer licensed in two states with an undergraduate degree in Accounting and Spanish American Literature. I have traveled to 44 different countries and lived for various lengths of time in 4 different countries. Before meeting DH I had dated a lot, worked in a wide variety of fields, and lived on my own for a long time. Long story short, I lived a lot of life before meeting DH.

DH's had just as much life experience or even more than me when we met. We fell head over heals in love very quickly. I gave up a JAG commission to marry him and follow him wherever the match led us. We had the fortuitous good fortune of accidentally getting pregnant earlier than planned. (Translation: we moved our wedding date up to accomodate our little guy's arrival).

Although those who had gone before us told us that surgery was hell and that the marriage survival rate was dismal, we were smug about our chances. After all, we were accomplished, mature, very in-love adults. Let others have their problems, we would not falter.

Now we are 5 years into a general surgery residency, far away from our families with two small children. For clarity's sake, we are in our second year of research with plans to do a pediatric fellowship. Both of us have said that this is inordinately harder than we ever expected. Both of us are suprised at how close we have come to rock bottom. (I should mention we have seen a marriage counselor over the fellowship issue because I just don't know how much more I can give for his dream).

Additionally, although it is self-evident to most people, I can't believe how much I love these kids now that they are here and how much I want to be with them as much as possible. (For the record, I'm not the most selfless, kid-oriented person on the planet either. Indeed, I harbored doubts during my pregnancies about how kids would affect my needs, wants, and desires. ) lNonetheless, we love these kids more than anything. DH's hours, the stress of his career, and the fact that we are so far away from family breaks our hearts. We simply were not prepared to feel this way.

Oh yeah, my career. At best, I am a mid-level bureaucrat seeking to go very, very part-time. In 2.5 years, I will leave this local bar and go to another legal community where I will start over again at probably an even lower position than I am now. (There can be no corporate ladder climbing while I follow DH around the country). Day care drop offs and pick ups? Me. Sick days? Me. I could go on but you get the picture. Meanwhile, Sallie Mae sends all her love every month for my student loans while I have severely diminished my earning capacity.

I wish you all the best in the world. I hope that you find a way to negotiate a life that can meet all of your dreams and goals. The few female surgeon/mothers with whom I have REALLY discussed this topic have expressed their doubts about the wisdom of their decision. (Including stories of low birth weight babies because they had to work so hard, breasts leaking during surgery, regrets that they missed entire chunks of babyhood, having to pay a nanny more than they earned as a resident via a loan, etc.). Further, Surgery still is a very macho field. Heck, I work for the Government and they act like my maternity leave is this huge, grand gesture. But that is another story.

Here is a small modicum of hope. Truly, it is doable. I just wouldn't recommend it. I feel badly for telling you all of this. I wish that I could give you a fairy tale, but I can not. Even my DH who is downright passionate about surgery will tell you that this is a damn hard way to go. He has second guessed himself on many occasions.

Good luck,

Kelly

[HeartRN]

I tend to agree with a couple previous posts...although this is obviously a highly personal decision, what would be wrong with waiting? I will be 33 in March and DH and I were married almost 9 years before having our first child. She's almost 14 months. Although I felt the clock tick long before we had her, you better BELIEVE I'm happy we waited. Even though he's not doing surgery, the internal med/cardiology fellowship/PhD route hasn't been very kind hours-wise either. And I was the ignorant one--who would have known that after this fellowship, he could do a fellowship on top of a fellowship?!? In fact, the time he has had to spend in the lab for PhD stuff versus clinical time has sometimes been more extensive. Whatever you decide, I wish you nothing but the very best.

[DCJenn]

The medical lifestyle is really, really difficult at times, and surgery is the most difficult of them all.

The facts are that really- we don't get to have it all- something has got to take priority. If you really, truly, passionately want to be a surgeon, then go, and do, and be proud of your determination to make it. You can be a surgeon and have kids. You CAN'T be a surgeon and give your kids 100%. Heck, we have guys here who are making it possible for their wives to pursue their medical careers- so we are all aware that it can be done.

I'd be interested to hear what Matt and Fluff have to say- or more importantly, what their med spouses have to say. We know what the female spouses of male surgeons feel- how will your husband handle that? Both Matt and Fluff have been really honest in how they've been treated by other people who don't understand the "Mr. Mom" role that they have committed to- like it's some wierd temporary insanity. There is not a whole lot of support for SAHdads- although it's getting better.

My husband and I are in our late 30s and are adopting and you know- I wouldn't have it any other way. (we'd be adopting regardless of age due to issues with both of us) I have busted my ass for my career and I love, love, love it. and I plan on doing something part-time in the soonish future and will probably continue to work in the long term future. I cannot even begin to contemplate how much a part of "who" I am is based on my professional success. Only now, after acheiving so very much do I even feel ready to jump off the bandwagon and only now do I feel emotionally ready to jump into the morass of motherhood.

My husband is fantastic but he in no way could handle staying at home, even part-time. My brother could, and did, and would love to be a FT SAHD.

Really, only you and your spouse can decide this- all we can do is give you our varying perspectives. Don't underestimate the impact of medical residencies and fellowships- they're more f-ing awful than anyone will ever be able to explain. It's one of those things where you have to live it to understand it. There is nearly NOTHING good about it. (and we have had it very easy with no money issues, no little kids, good friends, and excellent family support....)

Jenn

[Flynn]

Ditto to EVERYTHING Kelly just wrote.

Ditto to being smug about a GS residency and all the hardships.

Ditto to going to a counselor to get our marriage back on track.

Ditto to supporting my husband but seeing a limit to the word "support."

Ditto to loving my kids more than I thought was possible and embracing parenthood (not the most kid-friendly person here either). Raising kids is such a gift (cheesy but true).

Ditto to wishing my DH did ANYTHING but surgery....we've thought about other types of medicine so many times!!! (on a side note he says to me about two days ago he wishes he had done something else besides surgery...the costs are too high. DUH!!!)


I too had an emotional reaction to this post. It is such a loaded topic to me as a spouse and now as a mom. Kelly says it much better than I did.

Impossible? Ok so that's a bit strong but ignorance might be a little bit blissful here. We would have made other choices had we known more then...

Also something to point out....it seems that all General Surgeons are bright, workaholics who can do anything (most docs are) but when you match in a GS program you are with people just like you. You are surrounded by "stars" in their own right. If so many people before you have had a lot of trouble with this topic....LISTEN PLEASE TO WHAT THEY ARE SAYING. They were all stars too as I'm sure you are.

Anyway, I'm babbling...

[Flynn]

Well said Jenn and I like the strong language.

Just a little positive affirmation from "the angel of death."

Ha ha ..

Thanks everyone, for all of your advice and support. It's really helpful to hear from people who have been in similar shoes.

I'm in NY on the interview trail now--had my second interview today and have 2 more in the next 2 days. Then I'll have a few days back home with my husband before I have to leave again.

I know that the NY Bell Commission has set stringent 80hr standards. The residents I've met here say that the 80hr rule is closely followed, with occasional weeks nearing 90hrs. As sick and twisted as it may sound, the thought of an 80hr work-week is incredibly appealing. I wish I knew if it were really true.

I've been participating in the Harvard work hours study for the last 4 years or so. They have students and residents complete monthly online surveys documenting working hours, sleeping hours, study time, sick time, etc. Having kept tabs on my hours, I know that while on gen surg ward months, I averaged 110 hrs/week, had 1 day off per week, slept 5 hours when not on call, 2-3hrs on-call, and about 11hrs on my day off.

That comes to: 168 hours (in a week) - 110hrs working - 39hrs sleeping = 19hrs Free

So, an 80-hr week would leave 49 hours free (assuming I don't choose to sleep more). That's a huge difference!

Does anyone know if the 80hr week is really followed in NY or elsewhere? I have noticed that the residents here don't look as tired and burnt-out as elsewhere. For me, it would be the difference between having dinners and some quality time with my family during the week or only on the weekends. The NY programs also seem to offer nearby housing, which eliminates time wasted by commuting.

I know that there is no real way to prepare for what internship and residency will demand. I've accomplished what I have thus far by careful planning and time management, and I'm determined to find a balance between my family and career. I know my husband is worried that kids won't fit in the picture. So am I. For now, I think I need to explore my potential options, and find the program that best suits my educational and lifestyle needs.

My husband did his residency in California and finished soon after the 80-hour work week went into effect. He was scheduled for only 80 hours a week, but when you add on the mandatory lectures that he had to attend every single Thursday and Friday, that brought the total hours at work to 88-90. Since my husband is in Emergency Medicine, he often had to stay 1-3+ hours after every shift to follow up on his patients' labwork or dictate. If a patient came in 20 minutes before the end of his shift with chest pain, treating that patient could add hours to his shift. Those extra hours usually brought his weekly totals up to 100 hours. Of course, he wasn't on the clock if he had to stay after a shift or when he attended lecture, so the hospital was meeting the 80-hour work week requirement.

On the other hand, we have a friend who did an EM residency at a hospital not far from us and that hospital required far fewer than 80 hours a week. I can't remember how many hours he worked exactly, but he worked 2 days on, 2 days off. His residency program actually required the bare minimum hours required to graduate! DH was always jealous of his easy schedule but, last year, our friend's residency program lost their accredidation (sp?)...most likely because of the lack of training provided to the residents.

I'm not sure how the 80-hour week is in Surgery. Maybe with Surgery, when you're done with a shift, you're done. I'm sure some of the other ladies here will share their experiences with that specialty.

As far as managing children and work, you or your DH may want to check into working at a hospital that has a childcare center on site. DH's hospital during residency didn't have one, but the hospital where he works now has a great childcare center located at the hospital for use by the staff. I wish you the best in your decision-making!

Erica

Does anyone know if the 80hr week is really followed in NY or elsewhere? I have noticed that the residents here don't look as tired and burnt-out as elsewhere. For me, it would be the difference between having dinners and some quality time with my family during the week or only on the weekends. The NY programs also seem to offer nearby housing, which eliminates time wasted by commuting.

Welcome Surgspouse,
I too ponder over this very issue of when to have a baby EVERY DAY! I am 32 and my DH is PGY2 of general surg with pending plans to do pediatric surgery (which is a whole 'nother topic) I can't wait much longer to have a baby.
As I have had several discussions with Flynn and Kelly -I count my lucky stars every day that these 2 wonderfully, honest women participate in this board - I HONESTLY don't know where I would be without their advice. I hate to join the group of "angel of death" advice givers but please pay close attention to the advice given to you.
Let me start with the 80hr workweek for surgery residents:
DO NOT KID YOURSELF INTO THINKING THAT YOU WILL ONLY BE WORKING 80 HOURS A WEEK AS A SURGERY RESIDENT. I can say for a fact that my DH has put in 120hrs/week MANY, MANY times and not just during the first year. Can I get him in trouble by saying this?
It doesnt get better the second year as many will try to convince you. It depends on the rotations. Sometimes the hours are great and other times they are horrendous. During those hours he never even had time to return many of my pages and when he did the conversations were short-lived. The zombie and disconnected husband he is when he is home is a huge problem in our marriage. I worry constantly about his health as well. I can't even imagine as a woman trying to prepare for pregnancy let alone being pregnant when you may not even have time to brush your teeth in a 30 + hr timeframe. Your health and ability to maintain it, will be a big struggle.
We are in California and I have heard it is much worse on the east coast. In fact I have heard that places like the Harvard and Yale programs believe they are above the law, work their residents to death and simply pay the fines when they get caught. I could be wrong, but I see the truth as this: as a surgery resident you can work the 80 hours but if you want to stay in the good graces of your peers and your attendings as well as REALLY take care of the patients, you will without a doubt work more than 80hrs week. Remember, there are also many ways to get around the 80hrs/week:
"Its an average over a month"
"required lectures and such are not included"
blah blah blah....I've heard it all.
My DH intends on specializing in pediatric surgery which requires 2 years of research to be completed after R3 and a 2 year fellowship after gen surg is complete. What this means for me and a baby is moving every 2 years for the next 8 years to unspecified, most likely expensive places, working full time to pay the bills and raise a child pretty much by myself. In other words it would be similar to the life of a stressed out single mother who has to pick up and move every 2 years for my DH's "dream". It doesnt look appealing. Unfortunately, I am debating on whether or not I even want to bring a child into this stressful life (I am not a doctor but I will have to work for the next 8 years)

My recommendation to you is to plan a baby during research years after R3, if you plan to specialize or wait until you are finished with residency and take time off. I think it sucks big time that women in your position struggle with choosing between career and family, but in surgery it is the reality.

Another thing I can say, is that I wish someone had given me the honest "heads up" about the reality of surgery life before we matched. I don't like the sugar coated nonsense and the aspects of the life that are so conveniently "omitted".
As is, in my attempts to remain hopeful, we are considering getting pregnant starting may 2005.

[houseelf]

Lori,

Your response touched my heart. As a wife of a surgery resident, I still can honestly say that I have never once regretted having my kids. They are the best thing in our lives. It strains an already tapped out marriage, but they make our lives worth living.

Just so you know that you have alternatives, DH and I are very seriously considering taking out a physician Suntrust loan after he leaves the lab because I can't do it all anymore. I'm going back part-time, finances be damned. I Believe me, it is a painful decision to take out even more debt (I lay awake at night thinking about it). However, his choice to supersize his training has to be somewhat liveable for the rest of us.

Kris has the link for suntrust physician loans on the front page of this site. I tell you this just so you know that you have options, albeit damn hard ones, if you feel overwhelmed. I, for one, will not sit for another State bar and take whatever scrap of work I can find. The thought of increasing our debt makes me hyperventilate, but what are our choices?

Anyway, just keep this in mind, and have fun trying for baby.

Kelly

P.S. Flynn- Love the nickname is "Angel of Death". I have joked for a long time that mine should be "Little Miss Sunshine" because I'm always espousing the virtues of life as a surgery resident's wife. O.K. I'm out of here, I gotta go watch "Desperate Housewives".

[Flynn]

You guys are so good to have around! It is so great to read how other spouses struggle with this lifestyle and I'm not the only bitter one!

I was talking with my DH recently in regards to this post and the emotions it brought back to the surface for me. Although it's all relative I realize, we are doing really well with the last couple years of training and while it's no picnic, we're ok as a couple. It's a nice place to be!

This post however, brought up some very strong emotions I have compartmentalized and I was surprised to feel PASSIONALTELY bitter all over again. It's like I feel this responsiblility to be as honest as possible to hopefully STEER OTHERS AWAY from this crappy lifestyle. I know it's none of my business what others choose but I somehow feel if we knew then what we know now....I'd be married to an opthamologist or some other non-surgical speciality.

We both know that it will take years post-training to fully understand how all the sacrifice and hard times have changed us as people and as a couple. Now we are able to look back a bit and realize how crappy residency was...but we're still training and CT hours can be brutal too. I think because we are almost done I hate it less??? That's my theory anyway.

I was surprised to hear my DH say the other day that if someone were to give us 5 million dollars to do it all over again, he would say NO. He would NEVER want to live through a GS residency again no matter what.

I feel for you Lori. I remember my DH as an R1-3 and it SUCKED. I think things got a little better R4-R5...but "better" is a stupid word to use. Better compared to horrific? Yeah, that's a huge improvement when you start so low on the "livable" scale. (sarcasm)

I can say that having kids makes things easier and harder. I adore being a mom but I have the gift of being able to stay home (SAHM) and feel very very lucky. When the topic of children and general surgery come up I, again, get pretty emotional. I know my children would be different people if I wasn't home with them since my DH isn't around all that much. I am one person who does not think "you can have it all when you want to have it all." Nope. That's just way too selfish in my book. Children are precious and they don't give a d@#$ if you dig ditches or save lives. They need their parents. BOTH parents.

My DH stopped by the General Surgery interview lunch for the new applicants this weekend and had a hard time NOT saying, "Do you want to have a spouse? Kids? Then why are you here? You are making a choice that will make your future family MISERABLE on every level." There are some things that are more important than a person's drive, ambition, and "calling" in life. We can only hope that life post-training will be better than it is now. I can't even IMAGINE what we will do if it isn't.

Oy vay, you guys are giving me a stomach ache, though I really appreciate everyone's honesty. Personally I think it is WAY better to know what you're getting yourself into, than going blindly.

Ok, so here's my question... is it GS that is the worst of the worst, or are subspecialties just as bad? My DH is MS 4 and (hopefully) about to embark on an ENT residency. I know PGY-1 will be horrific. But I have hopes -- perhaps false hopes, but hopes nonetheless -- that things will gradually get better (read: slightly less intense in terms of hours) beginning with PGY-2. Or so that's the song that he was getting at a lot of his interviews.

We have an almost-18-month-old and were thinking of trying to time #2 to arrive during the research portion of his residency, during year 2 or 3, depending on which program he ends up at. Where we go will also dictate whether I SAH, WAH, or work outside the home FT.

Anyway... for anyone who knows about ENT and other similar specialties... do I need to drop the keyboard right now and run from the house screaming? (j/k) Just looking for a reality check....

Run! Just kidding, well maybe.
Kelly and Flynn might be able to answer this better than I....but I think it depends on the surgical subspecialty. My DH considered ENT for a while and I think that it would not be as bad as GS -- with the 1st year being the exception. One of the big turn-offs on that specialty was the GS intern year. (Saying that makes me feel like a real weenie in light of this thread!). I'm trying to think of the others....I think ortho is different in some ways but maybe just about as bad.....if you want to know more about urology ask migirl.
I had completely forgotten about how much DH liked ENT until reading this post! No wonder he is enjoying derm surgery so much right now. Ah, memory....

[Vishenka69]

Reading this thread made me once again feel very lucky that DH chose anesthesia. I still remember his surgical rotation during MS3 with horror. I was in the middle of wedding planning and told him that although I don't believe I should be interferring with his career, I will not be married to a surgion of any kind. My mom's cousin was finishing his GS at that time, so I was very familiar with everything his wife and son had to go through. Even though anesthesia is not nearly as difficult as surgery, we're still waiting until he's completely done with training. The way I look at it is - if I wanted to be a single mother, I wouldn't get married. Harsh, but that's the medical reality. :>

[migirl]

Hi Amy,

I just wanted to give you my experience with the surgical subspecialty of urology. I know it's not one that most people think of as being a surgical subspecialty, I'm not really sure why that is. Anyway, we are currently in the 3rd year of a 6-year program and I can tell you that it is 1000% better in terms of lifestyle than general surgery. Although DH had to do a general surgery intern year, the hospital that we're at is pretty humane to its residents and we didn't think it was too bad at all. Anyway, starting 2nd year it is all home call (not too many urologic emergencies!), starting 3rd year the number of calls dropped from 10-11 per month to 4-6 per month, and right now he probably works 1-2 weekends per month. The days aren't horrendously long, and I understand that the lifestyle post-residency is similar. It's a very family-friendly specialty; almost all of the residents in our program are married and about half of those have children. All in all, while I would have been supportive of DH regardless of which field he'd chosen to enter, I'm very happy with the field that he is in now and I'd definitely encourage anyone considering a surgical subspecialty to consider it. Just my $0.02.