mybetterdoctor

I spent today, Saturday, in the hospital playing doctor, while my physician husband took our three kids to a birthday party at Chuck-E-Cheese.  Though I generally dread working on weekends, my work today was more satisfying than my prior experiences at Chuck-E-Cheese have been, and in the context of the recent swirl of leaning-in and opting-out, I should mention I feel no guilt.

Communist Bulgaria

I was born in Bulgaria.  Both of my parents, as well as the parents of everyone I knew, worked.  As a child I didn’t know the careers of my friends’ parents, but I knew that if someone was home during the week, it was usually, and exclusively, a grandparent.  In a communist country with lots of problems that led us to leave when I was eleven, I also knew that my pediatrician was a woman, and my friend’s mom was a doctor.  My mother, who worked as a chemical engineer, and whose lab I would sometimes walk to after school, was in an office full of women.  Nobody had a great existential crisis over the relationship between motherhood and career.  True, in Communist Bulgaria we didn’t have women CEOs, we didn’t have CEOs period, and the semi-dictatorship and political life were male dominated – I’m not trying to paint a utopia.  But in the middle class of urban life, women worked reasonable hours, just as men did.  They got good pregnancy and maternity leave, then they dropped their kids off at the affordable, state-run day-care and went back to their jobs.  Everyone accepted that marrying, having children, and working were integral parts of life, and while few had the luxury to “find themselves” with their careers or employment, none viewed work and family as mutually exclusive.  They were both desirable, and achievable, and mundane.

Moving to the US was the first time I met the variously liberated and unliberated women of Mad Men.  The culture shift was insidious but omnipresent.  The sit coms had the stay-at-home mom spatting with the working, absent-minded dad who did little around the house or to take care of the kids.  The gender role reversals in one of my favorite sit coms growing up, “Who’s The Boss,” seemed refreshing –  it was Angela who had a career while Tony, the dad of another broken family worked as her housekeeper.  But of course, Angela was divorced, and that seemed to go without saying.  What I saw on TV contrasted with what I saw growing up.   Both of my parents shared the load equally, and in an experience that is common with immigrant children who have difficulty distinguishing between what is typical of their family and what is representative of their departed country, I believed that was the norm elsewhere.

I went to a boarding tennis academy during high-school, where the coaches were mostly male, and “you hit like a girl” was an insult, even when said to a girl.  The girls competed against the boys, and beating boys made girls more desirable, not less.  Anna Kournikova was hitting next to us, after all, and being pretty wasn’t about make up or nice clothes, but about athleticism and winning, and wiping sweat off your brow.  In college, majoring in engineering, I  was used to the male dominated classes, as were my friends who were going into computer science or physics or math.  On the wards during internship and residency I liked being on the surgery service – I enjoyed the mostly male environment.  But the people I admired most were the few female trauma or general surgeons.

It was during these years, that the competition among women started – the early competition – the one before we have SAHMs vs. the opposite – the one where the woman investment banker can party with the men, but they lust after the attractive teacher, while the banker always goes home alone.  This “competition” in medicine is felt as soon as medical students become uncertain doctors.  The (mostly) female nurses view the male interns as potential mates, while the female interns are the competition.  As interns we felt this strained interaction, but for men it was even more apparent – one friend told me how an older nurse had offered to set him up with some of the younger nurses if he was interested.  This competition existed also because sexism isn’t just for men.  Women make it high up and rather than say that they made it, so other women can, they say (or think) that they made it because they’re not like those other silly women with their make up, or handbags, or (gasp) babies.

A Bitch

I’ve heard nearly all women physicians in their 60’s I’ve met described, at some point, as “a bitch,” by women of my generation.  Perhaps the men share this sentiment but are too enlightened to think they can get away with airing this opinion.  To me, it seems, this noun must describe either the personalities of those who managed to survive becoming successful physicians back then, or the personalities they had to develop at work to be respected.  Better a  bitch than someone to be walked all over, I would think.  And personally, I didn’t agree with the assessment, but I am biased – I generally have very positive counter-transference to women in power.  I admire them, and I want to be them.  I think they’re the cool girl who’s beating the boys on the tennis courts and while the others sulk, she walks away with a trophy.  My sister played a tennis match against a girl when she was twelve, and while she was winning handily, the audience comprised the girl’s friends and family.  They would rudely clap at every mistake my sister made, every missed shot, every ball in the net.  My sister, no stranger to the ugly side of junior tennis, hit an ace, then put down her racket and clapped for herself.  I wasn’t there to see it, nor were my parents.  I’m sure we had other places to be, other battles to fight.  I know the story because she told me.  I saw these women physicians as the “bitch” who had to clap for herself, because everyone else was cheering for her to fail.  But she won anyway.

For all my anxiety of never finding anyone to marry, my plans to go to a fertility clinic at age 35 if I hadn’t met anyone before then, I met my husband during residency.  It was easy, and unexpected.  And while I spent the first half of my internship anxious about finding love, much as my single female friends did, I spent the second half in love.  For the first few years of our lives together, my husband did the lion share of the domestic work.  In part because, due to the different demands of our chosen subspecialties and my being a year behind him in training, I always had the harder clinical schedule.  In part because, he liked to cook, he had high standards for cleaning, and he didn’t own a month’s supply of clothing, so he needed to do laundry weekly rather than monthly.

We had our first kids, a set of fraternal twins, after the end of my clinical fellowship, while I was working in the research lab.  Having a baby is one thing, but having twins, and far from family, is a whole other disaster.  While my work offered a generous three-month leave, those three months were the hardest I’ve ever endured:  far harder than internship, residency or fellowship. For three months both my husband and I didn’t get more than three consecutive hours of sleep, and at the end we were ready to kill ourselves and each other!  We both worked all the time caring for the kids and managing the housework.  The laundry was endless, the breast-feeding, or more often the pumping, the bouncing on the yoga ball and singing songs, carrying two kids and two car seats up and down three flights of stairs – it was brutal.  I slept less, but I also tolerated sleep deprivation better.  And also I slept less because I had to pump.  Because of the combination of maternal hormones, and the small one-bedroom apartment where we could hear every floor board creak, I was awake with every whimper.

When I was pregnant with the twins and giving a research presentation, one woman, a Ph.D. scientist came up to me afterwards.  She had a nine-month-old son at home, she said, and was full of unsolicited advice.  “I stopped working 40 hours a week,” she said.  “I didn’t clear it with anyone, I didn’t tell anyone, I just did it.” This may sound idyllic, but, in fact, she is a research professor.  No one cares how many hours a week you work because if you don’t get grants and publish papers, you can work 100 hours a week, and no one will keep you on.  This is the career my husband had during our time in San Francisco.  No one looked over his shoulder, but it’s like running a small business – eventually you’ll run out of business.  We both took about three to four months of maternity/paternity leave working from home or in between as best we could, and then we tried to make up for it when our nanny started.

The Cost of Childcare

I had assumed we’d put our kid in daycare when I was pregnant until I found out that the UCSF sponsored daycare 1. cost $1,875/month and 2. had a two year waiting list.  Once we learned we were having twins, we knew that a nanny was our only option.  A nanny salary in the Bay Area at the time we were looking, for twins, was $18-25/hr.  As one of my attendings helpfully calculated, that salary was higher than what I was making post-tax as a fellow.  Had that been my full-time, regular job and not a path on a career, it would have made absolutely no economic sense to keep working.  Had I had a perfect world to concoct, I’d have liked to stay home for one to one-and-a-half years, though honestly I’m not sure I would’ve been able to handle it.  After four months with twin neonates at home, going to work for 40 hours a week and completing the rest of the 128 hours of childcare labor at home  seemed like a vacation compared to being mom 168 hours a week.  Before I had kids, when I heard of a stay-at-home mom having a nanny a few hours a week I wondered what she did with all her free time.  After twins, I didn’t know how any SAHM survived without at least a few hours a week to herself.  And no, unsynchronized twin nap schedules or three to six hours of night-time sleep do not count as “rest.”

Had I taken the time off, which probably would have been feasible for my career, I would’ve delayed our ability to “get real jobs” and move.  It was clear to us that staying in San Francisco, where we always had one fewer bedrooms than children, was untenable.  And so, for all these reasons, there was no “opting-out.”  In fact, I started working some weekends moonlighting at a private practice to help our ridiculous expenses.  “We’re the poorest rich people,” my husband liked to joke, and I’m certain anyone living in a major city can relate.

And since we had planned on at least two pregnancies, we  decided to have a third!  The twins were bigger, my work situation was reasonable to have a baby – during my research fellowship I worked few weekends and no nights.  Unlike with the twins where I could barely stand or do much after 32 weeks, with my singleton pregnancy I was taking care of the twin toddlers and was at work the Saturday that I went into labor at 39 weeks.  Every pregnancy is different.  Every baby is different. And every family is different.  With my singleton pregnancy I was the power mom pushing on, with the twins I could barely stand or do anything.  And yet, with the twins I had it better than many of the women I was reading about on the San Francisco Parents of Multiples forum.  They had bed-rest for months, bleeding, premature babies.  I was luckier than them, but it wasn’t because I had “chosen” to lean anywhere.

The San Francisco Parents of Multiples Club

The SFPOM was a support group for those of us going through parenting infant multiples.  Amid the variety of adversities of all kinds faced by its members, it offered a place for new parents to hear that “this too shall pass,” for parents muddling through twin toddlerhood to process their PTSD from surviving twin infancy, and for all of us to support and advise each other.  In contrast to many of the “mommy wars” going on around us involving mothers of singletons, as parents of multiples we were acutely aware that our ability to breastfeed our term infants was hugely helped by the fact that they were not born prematurely and were home, not spending weeks in the Neonatal ICU.  We knew that the moms staying home often had it rougher than the moms going back to work, and that even the astronomical fees for a night nanny were not a sign of luxury or privilege, but, as one member put it, “cheaper than divorce, or suicide.”

Three little kids will strain anyone and anything.  While for the first part of our marriage my husband did the majority of the house-related work, during this next part, it was I who was waking up at night, I who would look for, hire and communicate with and pay nannies, I who would pack up food/snacks/diapers when we went out, etc.  He did a ton of work as well, to be sure, it was just that there was so much more to do than the two of us could manage.  Exhausted and pulled in all directions we’d have the same domestic fight over and over again. Me asking for more help, him saying he’s doing more than any other man, and both of us exhausted with no reserve for anything.  This fight was playing over and over again on the SFPOM list-serve and I set up a survey for the members, which was eye-opening.  First, several survey respondents noted that they “do more work” than their “nonexistent spouse.”  This was San Francisco, and a club of multiples, we were, on average, older, better educated, wealthier, and more likely to be gay or infertile.  Some women worked, some stayed home, some had part-time work and had tailored or scaled back their careers to accommodate their growing family.  Many noted struggles with equity in dividing up housework and childcare and a large proportion noted a discrepancy in perceptions of who worked more: each partner believed the other had it easier.  On the list-serve some women reported divorcing over these rifts, others nearly had, but had stayed mostly, as one woman put it, “because I thought divorce would leave me with fewer resources than I already had.”

One gay dad noted that he had broken up with his partner of many years over his desire to have children, and his partner’s reluctance to parent.  “If I’d thought I could’ve enjoyed my partner without being resentful, I’d have stayed,” he said foreshadowing  the resentment many women expressed over their husbands.

Gay couples had more equitable labor distributions.  It seemed, at least from the outside, that when two men or two women set up a household, they were less encumbered by the traditional gender roles forced on them from all sides, and could negotiate the challenge the way it suited their families.

One woman’s email still haunts me as an example of how we haven’t come far at all.  The mom, the sole breadwinner for the household, complained that “it’s just not fair” to be handed the twins at 530pm when she walked in the door, while her husband, the stay-at-home dad, went off in the den to relax.  “I’ve had a hard day at work, too,” she protested.  I could sympathize with the dad – whenever I was alone with the twins I would count the minutes until my husband got home and could help.  But still, I struggled to imagine a stay-at-home-mom handing off the kids to the career dad at the end of his work day so that she could have a break.

Career Reentry

We moved to Salt Lake City, and there, too, we were lucky.  Our careers worked favorably that the jobs were a great fit for both of us in a terrific place to live.  We didn’t have to make difficult decisions favoring one career over another – but it was luck – luck over what subspecialties we had trained in, what research interests we had and didn’t have, and what job opportunities existed.  I chose wisely.  While my husband’s specialty has little night and weekend call, my specialty can have a ton, or some, depending on the specific job.  One of my professors in medical school had told me the story of how he became a pulmonary-critical care physician and then took a job that sounded good but ended up completely burning him out.  He quit and was considering leaving medicine altogether until he decided to go back to primary care.  In this new position, he valued teaching housestaff as well as taking care of patients.  That cautionary tale stuck with me as I looked at the opportunities available.

I tried to go back to work part-time.  My maternity leave with our third son was ending right at the transition into my new job.  I thought I’d work part-time for three more months, which I quickly discovered was 70% work for 50% (or in my case because of the terms of the part-time job, far less) pay/benefits.  My part-time work experience was not unique.  I knew female physicians and lawyers who worked “70-80%” instead of full-time in order to have only a 50-60hr a week job instead of an 80-100hr a week job.

Many of my friends from college were becoming moms at around the same time.  I went to Yale for undergrad and while I remember fellow classmates once exclaiming “Forget finals, marry rich!” we were a collection of ambitious women and men.  Some of us continued in our various careers after entering motherhood.  Others decided to stay home with their children.  And while from the outside it may have seemed as a dichotomy, a closer look showed that those of us who stayed had the types of jobs that were generally sustainable, or we had made them sustainable, while those who left careers to stay home with their kids had more difficult alternatives.  For example, all the physicians I knew who trained in large cities did not have children until they were past the most demanding years of their training, or they had had children between medical school and residency, or they were men.  On the other hand, a Ph.D. in the humanities doesn’t obviously translate into a career as a professor at a university in a city where your spouse might also be employed.  In those cases, staying home with the children may well be the most fulfilling and economically sound decision for the woman and the family.

Having stayed home with infant twins and then, for three months with three boys under the age of two, I understood that being a SAHM was not a vacation.  Another friend, who continued to work at her fulfilling career that reasonably fit in with her family life seemed annoyed that all these smart women we knew were “wasting” their talents.  “I think I’m jealous of them,” she said though, which probably was an important part of the story.

But these are smart women and they are ambitious, and a few years later, being mothers seems to have focused their ambitions.  Surfacing from the fog of babies and toddlers, they are emerging to be writers, starting their own companies, or pursuing other careers.  I don’t see their choices as all that different from mine, really, in that I’m not sure it was much of a choice at all.  They were working when they became moms, but their jobs didn’t have a clear career path where the ultimate goal justified the struggle to stay in.  They were fortunate to have the means that not working was an option, and they were now using these years as a spring-board for a second career.  In some ways motherhood seemed as a “graduate  school” of sorts, where you work hard for little or no compensation, learn a lot, transform in ways large and small and emerge a different person.  You come out with a degree, “mom,” that the rest of the world is unsure is even worth anything… but it’s worth more than meets the eye.

As much as I like watching the TV show Mad Men, I look at this alien 1950’s American culture and blame it for the divide.  Who decided that women had to stay home or choose careers, but not have both?  That men, because they had stay at home wives to raise their children and earning pressure to support a family had to work long hours – whether over cocktails and cigars or in the operating room?  Hours that are not only undesirable, but untenable for most.  Why can’t we agree that we want it all – both women and men – we want to have families, to have careers where we get to learn and think and problem-solve and make the world a bit better?  Why do we sell ourselves short and vilify the others?  We don’t, none of us, have all that much choice.  We do the best we can in the circumstances that are particular to our careers, our relationships, our finances, and we continually struggle to redefine the balance.

We have these “debates” as if our children will forever be the six-month-olds who breastfeed every few hours and love us best.  But so quickly they get bigger, they play with their classmates, they have their own lives at school, much as their parents have independent lives at work, and then we all come home to share our experiences.  Who aspires to be the one left alone at home to clean and cook while everyone else is fulfilled?  It seems to me, the conversation should be far more about lack of affordable childcare for parents, reasonable work schedules, and the need for more opportunities in the work place for both, women and men.  The debate is focused on a small, privileged section of society, but perhaps it’s time we acknowledged that even that section is not as privileged as we’d like to think, and that we’re all just trying to do the best we can.