Every day, I either get woken up by kids when I am post-call, kiss their sleeping foreheads as I come home after a swing shift in the ER, drag my tired feet into the dining room to help with homework even though I really need to read for tomorrow's pimping session, or I leave at the crack of dawn to pre-round on the patients that I have to present at 6 AM before 7 AM surgeries (not to see my children again until right before they go to bed).
I have questioned my desire to become a doctor from day one. Not because I don't want to be a doctor, but rather because of what I had to give up to become one. Anyone reading this could say, "well, why didn't you go to medical school when you were younger and didn't have children?" The answer is simple. I would've had to go to medical school when I was 18 before I was a teenage parent. And the questions as to why I'm in medical school haven't stopped since I was admitted.
Why don't you just stop breastfeeding and give your baby a bottle?
Would you rather pick your son up from soccer or go to an evening discussion on new treatments for HIV?
You have how many children?
Wait, how old are you?
Don't you think you should be home with your kids instead of pursuing a career in medicine?
My advisor once asked me if I was sure I wanted to finish medical school. After all, I had kids and a family and all the things that they wanted in life, but never had the opportunity to have, because of a career in medicine. Can you even imagine being asked if medicine is the right path for you, by your advisor, after you are already in medical school? All of these things happened to me.
I entered medical school at 35 years old, a wife of eight years, a mother to three amazing kids, and as someone who saw herself more in the process of changing careers than maturing. I had, in my estimation, already grown up. Before graduating college I had raised my then three-year-old daughter, worked as a pizza delivery driver, compiled countless print jobs at Kinkos and worked for a food science R&D lab. After college, I had earned my MA in Chemistry and Biochemistry, published websites, essays and photography, worked in healthcare administration, married and had two more children, taught at three universities, helped run a doula program for women on medicaid, built a successful doula company in the San Francisco Bay Area, and survived the cancer diagnosis, treatment and remission of my oldest son.
As a first year medical student I was pregnant with my fourth and final child. I battled morning sickness through all of my first semester, almost vomited into a cadaver during a 90-minute anatomy lab exam, was back in the classroom by the time my baby was 11 weeks old, ate lunch during lectures so that I could express breast milk during lunch for over a year, and missed every single milestone of his first year. Nothing about being a mother in medical school is easy. The timeline of medical school is set in stone and any deviation from the norm—like having a baby—requires taking a leave of absence for six months to a year before returning to classes. There is no individualized learning plan to accommodate pregnancy. There is no "part-time" schedule for pregnancy or during the first year of your child's life to allow for meaningfully-attached parenting. The last thing any mother should have to do is submit disability paperwork and a doctor's note in order to pump breast milk, but I did that, too, to avoid grade reductions for providing my baby with human milk for the first year. When it came time for clinical rotations, I was again asked to submit disability paperwork in order to complete clinical rotations within a reasonable distance from my home, so that I could share parenting responsibilities with my husband. I reluctantly did this so that I wouldn't lose precious clinical learning opportunities. But why was I asked to do this in the first place?
If we were truly supportive of students with families, then we'd create systems that support families. And since the majority of parenting work during pregnancy and the first year (if breastfeeding) falls on the mother, why don't we have systems like the Family Medical Leave Act (FMLA) in place for students? That's right folks—FMLA doesn't have protections for medical students, and at least two things tend to happen because of this:
1) Some pregnant students hide their pregnancies and go back to work 2-3 weeks after delivering their babies to stay "on track," a practice any medical professional would agree is not healthy.
2) Some students take longer leave than they originally desired, which in turn delays the time to meaningful employment and wage earning.
Medical school broke me time and time again. But I brushed myself off and got back up—because that is what a mom does.
During medical school I gave birth to my last child, sent my first child to college, failed my medical boards, almost got divorced on multiple occasions, and had to spend six months away from my family during my fourth year to secure myself a residency. I persisted when everyone thought I would fail. I did so by sheer force of will, with lots of hugs from my children (and lots of cookies). My littlest is now five years old and still wants to sleep with me and my husband every night because when I leave home, he's not sure if I'm coming home in one day or a month later, maybe two. I cherish the little things more than I ever have. I consider raising four beautiful, healthy children before and during medical school to be my greatest accomplishment. Parenting has taught me to be patient and understanding, to always seek advice when I don't know the answer, to give options that promote autonomy and independence and to acknowledge the people in my life who've made me who I am, who I was, and who I will be.
Who I will be—in medicine—remains a big question mark. When I finished graduate school in 2003 I had several competitive job offers. I got to pick which career I wanted to pursue with the training that I'd completed. When I started medical school, I traded my salary for med school loans to become a doctor. When I graduate medical school, I will be unemployed. What no one ever wants to talk about is that all this extra training didn't guarantee me a job as a resident. 3,936 graduating physicians are in the same boat—the biggest difference is that my boat is holding four kids, my husband, and two aging and ill parents. When the search for residencies began, everyone told me to apply everywhere. I did, even though my instincts were telling me that what my family and I really needed was the consistency and stability of staying in our hometown (with the support system that got us through medical school in the first place). I applied to 146 programs across the country, got 50 rejections and didn't hear back from 93. I had six auditions and one interview. I lost the residency lottery and there is nothing I can do about it.
Here is what I can do: I can speak out about how finding a residency harms families. I'm not the only student with a family who didn't match close to home. Last year one of my colleagues had to leave their spouse and newborn baby for residency! Why didn't they go with?—I'm glad you asked! Let's just say that it doesn't make sense to sell your dream home and force your spouse to leave their dream job. I can't say that it's better to split up any family, but we medical students are expected to do what we have to do, no questions asked.
But I have some questions:
Why doesn't home field advantage mean anything?
Why is the goal of medical school to move people far, far away for residency?
Why isn't there a system of protecting families from the disruption brought on by the match? If there is a couples match, why not a family match?
Why do medical students accept salaries in the $45K to $66K range when their programs get $112K per resident to train us and in some cases $155K? Are we that worthless? Or are the doctors before us simply unwilling to fix the system?
This is not how adults find jobs. I repeat: this is not how adults find jobs. New medical school graduates are not items to be selected in a store with specifications, dimensions and user manuals. We are not our board scores nor are we so mobile that we can uproot our lives every two to four years for the next step of the process.
We are highly trained medical professionals and should be treated as such.
Lisa began her career as a biochemistry researcher and her love of research persists today. She is completing her DO/MPH project describing the barriers that exist to accessing doulas for pregnant women on Medicaid and those with low socioeconomic status. Medical school has ignited Lisa’s passion for shaping reproductive health care policy; she can frequently be found lobbying the State Capitol for birth control access with local physicians, organizing student events and disseminating information for Medical Students for Choice or frequenting local talks about reproductive justice and abortion stigma. Lisa truly is a relentless advocate for patient-centered, evidence-based care; her capacity for empathy of the human condition is evidenced by her successful multi-generational care-taking skills, and the fortitude she’s exhibited mastering the art and science of medicine while doing one of life's most difficult jobs, with grace and aplomb.