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The One Class I Was Missing in Med School: Childcare

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In my short two-and-a-half years of motherhood, I have learned more about childcare than I ever knew possible. We tried everything. Daycare alone, daycare/nanny combination, live-in nanny, live-out nanny, multiple nannies, nanny/au pair/daycare combo. I never knew how challenging working parenthood could be, especially with no family in town. I believe that the childcare you choose is a decision tailored to your family and your children, and you will not know what you need until you are in it. This experience overshare is solely meant to be educational.

The only universal advice I can give is, be flexible and ready to change if you feel like you or children are not thriving.

When my daughter, Ava, was born, we were lucky enough to have a young and flexible nanny who loved Ava so much. She was punctual, willing to work late, odd hours, weekends, and at the last minute. She even came in the clutch last minute at 5 pm when she was working a different job and watched Ava in the clinic while I gave an adrenal lecture to my peers and superiors. Looking back, she was a huge reason I was able to finish fellowship because “nobody cares about your child at home when you are the fellow on call.” Yes, I was actually told this. The con of having a nanny as a fellow was that my husband had to work three jobs on top of also being a fellow for us to afford childcare, which meant him being away for weeks at a time. Somehow we made it.

When Ava was an infant, we did exclusive daycare for about four months. For us, this was hard. It was the winter in Pittsburgh — she got sick all the time. She had severe stranger anxiety, so she had a heart-wrenching meltdown every single morning. Starting every day like that wore on me. Pick up was also terrible. As a physician, even more so as a trainee, your end time is unpredictable. Your day could be going great, then BAM! Someone shows up at your clinic at 5 pm with chest pain. Or worse, your attending wants to discuss some esoteric topic because you finished rounds early. Daycare closes at 6 pm. I’m embarrassed to say how many times I called daycare frantically to tell them I’ll be there in ten minutes, please stay with my child. My daughter was always the last child picked up. I felt like the worst mom every single morning and every single night. This was a coveted daycare in the city, with mostly doctor parents and an over one year waitlist. Still, this was not for us. By some stroke of luck, our nanny who was with Ava in the beginning again became available to us, and we never turned back.

When we moved to San Antonio, Ava was 18 months. We temporarily put her in daycare so we could study for boards. This time she was ready and adjusted pretty well. I was so traumatized by my previous experience, that we decided to go the nanny route once I started back at work. Our nanny, who was studying to be a teacher, brought her own daughter, so my daughter got the benefits of socialization and education, and I got the convenience of her being home. The problem we didn’t realize was a problem until much later was that our nanny was working too much. We paid her overtime, of course, but still, she was working more hours than us, and we work too much.

My daughter was two when my son was born. We had a live-in nanny/housekeeper for his first six weeks of life because our previous nanny started her career as a teacher. Initially, this was helpful for me post c-section, but we noticed quickly that our toddler needed to get out of the house. She needed structure, other kids, and more activity than a single caregiver could provide. Also, I was going nuts with the toddler jealousy leading to knees in my abdominal wound while nursing my newborn. It took longer than we hoped, but she got off the waitlist for “school” when our baby was two months old. This time she adjusted quickly. She loves it. She needed it.

As my return to work approached, we knew our son would be at home. I was over the complexity of breastmilk and daycare in addition to everything I mentioned above. We calculated the hours we would need for childcare and realized that one caregiver was not going to cut it, and the amount of overtime was not even cost-effective. We now have a live-in au pair, a part-time nanny, and our daughter goes to school. It sounds completely ridiculous, I know, but this is what we need to make our life work with two unpredictable physician parents starting their careers.

My schedule is so tight that I cringe when I have to go to the bathroom, but I love that every day I change people’s lives in and outside of my home. Every day, I can still nurse my son, thereby holding him exclusively for at least 90 minutes. Every day, I can take my daughter to school, feed her dinner, play with her outside, put her to bed, and chat with her about two-year-old randomness.

The working mom thing is not all it’s cracked up to be — it’s so much more. It’s wrought with mom guilt, sweetened by the joy of patient care, soured by unpredictable work and made full with treasured, “I want mama,” toddler whines and a tiny boy who jumps out of our nanny’s arms the second I walk in the door.

Arti Thangudu, MD is an endocrinologist and a 2018–2019 Doximity Author. She specializes in Endocrinology, Diabetes, and Metabolism and is a mom of two beautiful kiddos under three! She writes a blog for other working mamas, She has also contributed to Medscape, Doximity, and KevinMD. Outside of work, Dr. Thangudu enjoys traveling, cooking, and spending time with her husband and two children.

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