August 5, 2009

A Drop in Pressure

With two young children at home and her training in front of her, a pediatrics resident is torn apart—until she decides to go part-time

By Susan Clinton Martin, M04

“Can you keep them awake a little while longer?” This was becoming a daily plea as I crawled down the highway heading south out of Boston as fast as traffic would allow.

I was a pediatrics intern in the Neonatal Intensive Care Unit at Brigham and Women’s Hospital, and after a long day caring for babies who could fit in the palms of my hands, I longed to hold my own eight-month-old infant and his three-year-old brother. “I tried,” my husband replied, “but they’ve fallen asleep on me.”

“The ability to do my residency on a part-time basis truly made me a better physician, wife and mother,” says Susan Clinton Martin, here hosting a birthday party for one of her sons. Photo: Courtesy of Susan Clinton Martin

Mine was really an unreasonable request, as my family never knew exactly when I’d make it home. One of the jobs of an intern is to master efficiency in taking care of patients and of the numerous clerical duties that accompany it. I, obviously, was still working on the efficiency part.

My first son, Liam, was born between my second and third year of medical school. I was 30 years old, my husband five years my senior, so it seemed like a logical time to start a family. I have always had an interest in child development, so I was looking forward to spending several months at home with Liam, experiencing each exciting developmental milestone. It was a very special time. With a supportive husband and my sister as my nanny, I was able to handle the demands of my remaining years of medical school without too much difficulty. So it was with that sense of confidence (or maybe I should say, overconfidence) that I continued ahead with my plans to add another baby to our family and pursue a pediatric residency at one of the country’s most rigorous training programs.

The Boston Combined Residency Program in Pediatrics is a unique program that melds the strengths of a leading research and teaching institution, Children’s Hospital Boston, with a leader in primary-care training, research, advocacy and public health policy, Boston Medical Center. I was thrilled to be accepted to a program that matched my interests so perfectly.

I remember being at my intern orientation and one of the assistant program directors asking me, “How are you going to manage this? Are you really commuting from Hanover?” Again, I was full of confidence that I could repeat my track record from medical school.

My husband, who is in computer software sales and has a more flexible work schedule than mine, was tirelessly supportive, and my sister loved my children like they were her own. Also, my parents were recently retired and loved to help out in any way they could. It was because of this support network that we had decided to live on the South Shore, despite the commute, which could take well over an hour during peak traffic. So, practically speaking, we had a plan that should have set us up for success.

Then reality hit. As many parents will tell you, having two children is much more difficult than one. At least when you have one child, that child eventually falls asleep. Not so with two. And you know how I secretly took credit for my “easy” firstborn? Well, his little brother was a different child altogether, and I was not going to take credit for that! Sweet and innocent, to be sure, but never one to sleep in his own crib an entire night through. So between my long hours at work, including overnight call every fourth night, and a baby who didn’t sleep, our best-laid plans were starting to unravel.

More powerful than the sleep deprivation, however (and most definitely exacerbated by it), was the emotional toll that being separated from my children was taking on all of us. Leaving early in the morning before they awoke and coming home after they were asleep meant that we could go days without seeing each other. Eamonn, my youngest, was in the midst of his stranger anxiety phase and would burst into tears whenever he would see me. It was breaking my heart. My remedy for this was to essentially treat my “post-call” day (i.e., the day following a 24- to 30-hour shift) as a “day off.” I would leave work, drive home bleary-eyed and jump into the daytime activities like a “normal” mom. Many people around town can probably recall seeing me at school functions or birthday parties with a dazed look on my face. 

Obviously, I was not able to pull this off for long. After one Saturday call in October, I arrived home the next day with plans to go with my family to an art festival at my son’s preschool. I anticipated an early bedtime for everyone that night, but what I didn’t anticipate was that my younger son would get sick with viral croup. When I heard that first seal-like, barky cough, I knew I was doomed. My husband and I spent the remainder of the night up with Eamonn, trying to keep him from crying to avoid exacerbating his cough. By the next morning, I could hardly get myself up and out to work. It was that morning that I decided my work-family balance was seriously imbalanced. I needed a change.

Doctor, Wife and Mom

I approached one of my program directors that day with my tail dragging between my legs. I felt like a failure. I thought I needed to quit or else somehow postpone residency until five or 10 years down the line, when my kids were older. But the response I got was overwhelmingly supportive. I was told that my program was invested in me and that there were ways we could modify my schedule to achieve a balance that benefited everyone. I was so relieved. I jumped at the option to work every other month and stay home with the children in the intervening months.

During my “off” months, I would continue to work one afternoon per week at my continuity clinic to maintain my clinical skills and accessibility to my patients. Fortunately, my residency program was large enough that these schedule modifications did not significantly adversely affect the other residents. We were also expecting a transferring resident at the time I made the switch to part-time, so he was easily scheduled into my open slots.

The ability to do my residency on a part-time basis truly made me a better physician, wife and mother. During the months when I was working, I was able to give 100 percent of my effort without thinking about the time I was spending away from my family. I felt secure knowing that I would be able to make up for it the next month at home. I became much more focused. During my months at home, I was now not only physically present, but emotionally accessible to my family. I wasn’t overcome with exhaustion or preoccupied with thoughts about work. I was able to actively participate in my son’s preschool classroom, take the boys on outings, to doctors’ and dentist appointments and lay them down to sleep at night. My husband could stop being Mr. Mom and dedicate more time to his work, which we depended upon to financially sustain us.

Although I started off alternating months at work with months at home, I quickly realized that my family and I could handle a couple of rotations back-to-back, knowing that we would then have a month off to re-equilibrate. Therefore, I essentially worked 75 percent instead of halftime. Given the inherent flexibility of the senior year of residency, I have chosen to finish this last year on a full-time basis, completing three years of training over four years. My residency program continues to be empathetic and supportive, even scheduling my vacation weeks during the children’s school vacations.

As I approach the end of residency, I am filled with anticipation. Over the past decade, often under duress, I have simultaneously realized two life goals: transforming myself into a pediatrician and mother to two beautiful children. It hasn’t been easy, but I wouldn’t have missed either part of it for anything.

Susan Clinton Martin, M04, graduated from her residency in June. She plans to pursue a fellowship in developmental and behavioral pediatrics at Boston Medical Center.

This story first appeared in the Spring 2009 issue of Tufts Medicine magazine.

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