What’s A Smart Woman Like You Doing At Home?

Current Commentary
Journal of Obstetrics and Gynecology
May 2002
Volume 99, Number 5, Part 1
Pages 832 – 834

It is 3 AM. Well, 3:27, to be precise. I just put Rebecca back to bed. At 23 months, she has not yet mastered the fine art of sleeping through the night. I, too, find a complete night of sleep difficult to achieve. After I am awakened—nearly every night—I find it extraordinarily difficult to get back to sleep. This is due, I believe, to years of taking call on the obstetrics or gynecology service during which uninterrupted sleep was a rare occurrence. Instead, I became accustomed to quickly waking to the sound of my pager, calling the number listed, and running to the location where I was needed. No matter how many hours it had been since I slept in a bed, I always found it difficult to get back to sleep for fear my pager would go off again. Instead, I often ate chocolate, drank coffee, and stayed awake. The sleep deprivation was chronic.

Residency is a barbaric training process during which new physicians can have the humanity literally worked out of them. After receiving a medical degree, the idealistic physician embarks on an impossible quest: to learn all there is to know about her specialty of choice. From the perspective of the residency program, training in obstetrics and gynecology is a more than full-time job. The dogma maintained is that residents must work as many hours as are humanly possible because of the vast amount of knowledge to be learned during the 4-year program. There is little consideration given to the variety of personal situations that occur, which might necessitate flexibility on the part of the training program. Childbirth is one such circumstance.

For many of the reasons that people decide to have children, my husband and I planned to have a baby during my fourth, and final, year of residency. There was precedent for this. In fact, one woman had a baby during her internship year and twins during her third year (she is one of my heroes, but that is a story for another day). So, when I became pregnant before the end of my third year of residency, I fully intended to complete my training.

I suspected that I might be pregnant about 30 seconds after I missed a period. I used a home test. As a clinician, surprisingly, I had no idea what the faint line I saw meant. My husband, Ian, and I rushed to my dad’s house. Also a physician, he drew my blood, and Ian drove it to the lab. Sure enough, I was pregnant. A couple of nights later, I was on call and bleeding. I thought I might be having a miscarriage and became very upset. Somehow, I had already become attached. Fortunately, an ultrasound the next morning showed the tiny flicker of a heart beating.

I vomited for 20 weeks. One day, I almost drove over a police officer directing traffic as I was rushing home to throw up. I scrubbed out of surgeries and generally felt awful. My migraine headaches became worse, and I was referred to a neurologist to make sure nothing more serious was going on. This baby wanted to make herself known. And, on my birthday, she did. Ian and I had had an argument, about what I cannot remember. I was feeling blue. It was, after all, a lousy start to my birthday. On my way to work at 20 weeks’ gestation, I felt the sensation of someone batting her eyelashes against the inside of my abdomen. Then it happened again, and again. As time passed, these little flutters turned into big rolls and kicks. Later, I could feel them on the outside— with my hands. I often thought about what my baby would be like. I could not wait to “meet” her. There I was, completely and hopelessly in love with the little creature growing inside of me.

By the time I was at full term, nearly every other resident had seen my baby on the portable ultrasound machine that was kept on the labor and delivery floor. And, at 39 weeks, I had a cesarean section and a wonderful little baby girl. I am told that my program director paged me during my section. Someone answered the page and learned he was upset that I, the chief resident on the gynecology service, was not scrubbed in on a particular case: “Why is Jill in a section? She’s on GYN, not OB!” Someone explained to him that I was not in a section, I was the section.

For the next 3 days, I was thrilled to have an almost constant barrage of visitors—residents, aides, labor and delivery nurses, operating room staff, attending physicians, friends, and family. I felt like royalty. At the time, I knew nothing about attachment theory. I only knew that my baby and I both slept best when we were snuggled up together. I planned on an 8-week maternity leave, which would allow me to graduate with the rest of my class. But as my leave dwindled, I became more and more sorrowful. I did not want to leave my daughter. Finally, the day arrived. I got in the car, set up the portable breast pump, pumped, cried, and drove the 45 minutes to work. My daughter was at home with her daddy, and my own mom was going to be her nanny. What could be better; right?

As I walked into the hospital from the parking garage, I saw my friend, an attending physician in GYN-oncology.

“You’re about to experience one of the worst days of your life,” she said. I, however, already knew that. I made it through that first day feeling very raw, lonely, and sad. I called home at every chance and pumped at every other. I did not want to miss another minute with my daughter, so I drove home on the rim of a flat tire rather than waste time changing it.

Shortly after my return from maternity leave, I was on call. That meant a 36-hour shift. Worse, it meant my first night away from my daughter, and her first night away from me. Somehow, I made it through the day. I was on call that night with my program director. Together, we attended the birth of a little boy. I cried as I missed my daughter.

Later that night, I went to speak with my attending. I told him I was miserable and could not stand to be away from my daughter for 2 days at a time, seeing her only as she slept before I left for work and when I returned home. Although I had the utmost respect for those who could, I felt I could not work a resident’s schedule and be the kind of parent I wanted to be. I asked him for a solution. He had none. My options, he said, were to continue or to quit. I requested a leave of absence, which was denied because it would necessitate a change in policy that the department was not willing to make. They agreed, instead, to let me extend my maternity leave for an additional 4 weeks. After returning to work for 5 weeks, I went back out on leave uncertain as to whether I would return to continue my professional training. My husband and I discussed our options and came to a decision that remains very difficult for me to this day. We decided that I would leave my residency and stay at home with our daughter. I was concerned about many things: What would our daughter think when she grew up? How could I explain the fact that I gave up my career to be at home? How would she learn that she has choices, whether to be at home, to pursue a career, or do both? How would my relationship with my husband change? How would I feel being financially dependent on him? And, importantly, how would leaving affect my fellow residents, whose quality of life would be impacted significantly by one less person to share the workload?

I still consider most of these questions. The one that did not require much imagination, however, was how leaving would affect my colleagues. They made it quite clear. They were angry, very angry, because I was increasing the demands placed on their time. Only one of them sympathized with me over the tremendous sacrifice I was making by abandoning something for which I had worked very hard. Others made comments like: “You’re making the biggest mistake of your life.” “A baby won’t even know you’re there.” Two of my fellow residents asked that I not attend my class’s graduation because they felt that I would be “rubbing their faces” in the fact that I “didn’t have to work.” One of them, a cancer survivor, shocked me when he said, “It’s not like you have cancer.” I found the irony to be profound; these were physicians who had chosen a specialty dedicated to the care and well-being of women and their fetuses. Because of the prevailing attitude in the residency program and the fact that there was little flexibility in it, the impact on the lives of my fellow residents was tremendous. As a result, they were unable to understand that I had made the decision that I thought best for my family.

I was a good resident. At least, I think I was; the patients liked me, and the nurses seemed to feel that all was under control when I was around. I felt good about those things. Now I have a wonderful little girl (what mother doesn’t believe her daughter is wonderful?). She is smart, funny, interesting, and, even on the tough days, a joy to be around. I like to think that having me at home has contributed to these qualities. Had there been another option, however, it is possible that I would have finished my training, perhaps on a part-time basis, perhaps after a leave of absence.

Over the past 2 years, I have changed dramatically. As the primary caregiver and advocate for a helpless little person, I have found strength and confidence I never knew I had. My priorities are also very different. And, instead of having sleepless nights while on call a couple of times a week, I have them with much greater frequency. Since my departure from residency, I have done a lot of reading on attachment theory, almost all of which maintains that it is vitally important for an infant to have a consistent, caring adult during her first 3 years of life. I am happy that in our family I could be that person.

Physicians need to take a hard look at the OB/GYN training process. Residency should be adapted to accommodate those who choose a part-time path in which to learn their trade. The desire to nurture one’s family as he or she sees fit should be supported. Whether a person chooses to complete a residency on a full-time or part-time basis should be just that, a choice. The resultant obstetricians and gynecologists will be much more satisfied with their lives. Children with happier parents will benefit as well. Had I been given the option to complete my residency on a part-time basis, it is likely that currently I would be contributing to the care of women, their fetuses, and to our specialty.

Back to tonight. After returning Rebecca to bed, I tried going back to sleep. Like countless other nights, that did not happen. Instead, I opened my nightstand looking for something to read. What fell out was a book I purchased months earlier entitled, What’s a Smart Woman Like You Doing at Home? By writing this I have tried, in my own way, to answer that question and to explain my choice. It is my hope that sharing my story will help to affect change in the ob/gyn training process.