Family and medicine: thoughts from the trenches

I was only able to attend a few sessions of the OPM convention this weekend but one thing has continued to gnaw at me. One presenter made the point that “Your family is the most important thing, but… med school has to come first.” Having been through it, I kind of think I know what he meant, but I am pretty sure that it could be easily misinterpreted by those who have NOT yet gone through this.
Basically, what I’d like people to come away with is the notion that your going to medical school and committing to a career as a physician is a commitment not only on your part, but on the part of your S.O./spouse. In the past, I have been scolded by some on this board for saying that it is a selfish pursuit, but I don’t care. Believe me, IT IS SELFISH. You are pursuing your personal fulfillment, your ultimate career goal, and you are asking a whole lot of other people to buy into it and support you while you do it. Seems to me that’s a definition of selfish.
But before everyone starts spluttering and putting the caps lock on for your replies, and before I’ve gotten into my asbestos suit, let me say a few more words, okay? I don’t think that there is anything wrong with wanting to achieve your dream job, your career goal. I wish more people could feel free to do it, really - I am awfully happy with what I’ve been able to do and I would certainly wish that sort of happiness for others. It’s fabulous.
Moreover, one can take that “selfish” argument and turn it around. If you know that you really, really want to be a doctor, so that it is eating at you and you just can’t see yourself doing anything else… if you try hard to envision yourself in other pursuits and feel dissatisfied… if it really does seem that some portion of your happiness is wrapped up in this career pursuit… then a spouse/s.o. who persists in NOT supporting your pursuit is also being selfish - or at least at first glance it would seem that way.
BUT. (I am like the old Miller Lite commercials, I feel very strongly both ways.) The difference is that you are sure about what you want to do and what you are willing to give up to pursue it. Your spouse/s.o. is not nearly so sure. S/he is beset with fears and doubts. What is this going to mean for your relationship? What is going to happen to your family? What is s/he going to have to do to keep you happy? What is this going to mean for his/her career?
And the hell of it is, you can’t really reassure him or her. You don’t know what it’s going to be like, either. It is a scary unknown for everyone and you would be well-advised to recognize just how very scary it is for those who love you and WANT to support you. When they sound less than enthusiastically supportive, consider that they are terrified of the unknown - what is going to happen?
You can’t just expect them to dutifully nod when they hear, "Medical school comes first.” That is crap, frankly. If your spouse has The Presentation of His Career at work on the same day that you have your pathology final, but your two-year-old has a 103-degree fever, and needs to be taken to the doctor, this is not the time for a game of career chicken: “Whose career is more important?” The right answer is: we’re in this together, everyone’s future is at stake, and we all have to work together to support each other. Your demanding, inflexible, challenging schedule does NOT make you more important than anyone else.
You need to tell them over and over and over again that, in the ways that really matter, THEY come first. Then figure out what really matters in your family and stick to your pledge to keep them first. And be sure to be really, really appreciative of their support and the ways in which they are changing their lives in order to support your pursuit. What you’re asking of them is a tough thing to do, and the worst thing you could do is take it for granted. The second worst thing to do is to expect it without indicating that you appreciate how hard it is.
As I wind down this little essay I’m a little surprised at my vehemence, actually – when I started out I didn’t expect all that. But I hope I’ve provided some food for thought, a challenging viewpoint, and a jumping-off place for your own discussions with the people in your life who matter.
Best regards to all the future physicians out there, AND your loved ones!

Hey Mary and Folks,
I spoke with many people who had so many concerns about losing themselves in the medical school and medicine career pursuit at the convention. I really believe that the take-home message from many presentors is that you have to find a balance. As you have eloquently stated in your post, this is not the time for a “game of Chicken”. It is not about who is more “important” but about how can we get through life and its trials together. Every career is about compromise and too much emphasis has been placed on “giving your life to medicine” with the exclusion of all else.
As I see it, medicine/surgery is not my identity. I am more complicated than that. Medicine/surgery is what I do for a living right along next to those little folks in the hospital that scrub the instruments that I use and clean my sleep room. We all have a role and as Dr. Freeman said, doctors “are not generally good at team playing”, but in the practice of medicine in the 21st century, we all have to work as a team. He touched on the fact that more that half of all medical students today are women and that women are in pursuit of medicine in record numbers. Perhaps with the influx of more woman (who have been a little better at finding compromise) we might see more emphasis on striking a balance with having a healthy family relationship and a healthy career in medicine. With the advent of the 80-hour work week (for residents but not attendings), I suspect that more and more, medicine/surgery will be more “family-friendly” and less "selfish"

As usual, thank you for the great insight into this journey. I would have to say that I walked away from the Conference with a better understanding of the balance that I need to have throughout this entire process and for the remainder of my life as a practicing physician, wife, daughter, sister, friend, etc.
For me, the key is in the balancing act.

Mary, thanks for your post on this subject.
It is something that my wife and I struggle with almost daily. She feels like once I get to med-school that’s the last she’ll hear from me for the next 4 years at least. Trying to reassure her, I explain that while school will be my main focus, I will still be involved in our marriage and raising our kids. We will have a life outside of med-school. It won’t be the same as it is now, but we will have a life.
Pursuing this dream is selfish. It’s by far the most selfish thing I’ve done in the 16 years we’ve been married. My wife didn’t sign up for this. It’s not her dream. In fact, she has even said that if she had known before we were married that one day I was going to head off in the direction of becoming a physician, she probably would not have married me. That sounds harsh I know, but I can understand where she’s coming from. When we were married, I was studying accounting. She thought I was going to be one of those 9-5 types who would be home every night by 6. Heck, for a couple of years I thought I was going to be one of those types.
I know I am rambling on, so I will close by saying that she is coming around. Our marriage is stronger than ever. I am thankful that she constantly fights the urge to be selfish and does her best to support me in my dream. In return, as I pursue this dream, I must constantly fight the urge to be selfish. It’s so easy for me to become consumed with pre-med things that I go into my own little world and forget about everything and everyone else.
When she sees your post it will be reassuring to her to know that someone who’s made it through to the other side feels and believes the way you do.

Thanks for this post. I think I’m going to print it out and put it in a place I can see regularly! I keep putting more and more demands on my fiance and then get freaked out when he doesn’t seem very excited about me and my goals. He’s a laid back hippie type and is uncomfortable with my fast paced style; I, on the other hand, get frusterated with him for being so unproductive. I keep thinking - you don’t work as much as me, if we have kids, you should be the primary caretaker - and I’m having a hard time hearing him say no, that’s not what I want. I often take it for granted how much he does support me and how proud he is of me and how unique and loving he is. When I go home tonight I’m going to let him know how much he means to me!

Mary, You hit the nail on the head. I so appreciate having someone who has experienced the same things that I have experienced. I hate to say it, but I refused to admit my selfishness for a long time. My Mom said, “Marcia, you are 38 and you have spent your entire life taking care of your husband and kids. You deserve to be selfish now. Go follow your dreams, you have spent far too long helping others pursue theirs.” So I will not flame you for telling the truth. I admire you for knowing the truth and telling others what they may need to hear. I made my husband read this. He read it at least twice, turned to me and said, “Very insightful.” Only someone that has experienced the desire to become a doctor and the uncertainty that she and her family feel as the whole process takes on its own life could say what you have said here.

Thanks for “putting it into words”. I am a single mom who has waited until the kids are almost grown to “do my thing”. Raising them alone has been a series of compromises, but when I decided to attempt med school, my son became the most supportive person in the world. He has been a saint who helps with cooking, cleaning, great behaviour, and just generally puts up with my totally stress-out moments before a final. We are a TEAM. I cannot tell him I love him enough. Relationships with SO’s are few and far between because the balance is so finely tuned, it requires just the right touch to keep it running.


If your spouse has The Presentation of His Career at work on the same day that you have your pathology final, but your two-year-old has a 103-degree fever, and needs to be taken to the doctor, this is not the time for a game of career chicken: “Whose career is more important?”

Great post! But with this question I wonder what folks would do? My first inclination was to delay the path final and stay at home with the child. If my exam was in the morning and his presentation was in the afternoon, then he could take the child to the doctor in the morning then after the exam, I’d take over while he did his presentation at work. If this didn’t work, I’d ask the course director to let me take the exam later in the evening.
So I’m curious if I’m asking too much of the school in this situation? During the 3rd quarter at Hopkins, I was out with Bronchitis for a week at the same time my child out with the flu then had to leave that Sat for a presentation at a meeting in Texas for a week. When I, along with a guy whose father had died asked for a 2 day delay in taking the final we were both told a resounding NO!!!. I know at other schools (EVMS) parents are often given late (a day or 2) exams when their kids are ill.
What I’m checking into now are schools that would at the very least offer some flexiblity. In my mind, any school that wouldn’t excuse a student whose parent died just before an exam, isn’t worth attending. Life happens and people should have some compassion for that.