So Where's My Medal?
http://www.100md.com
《新英格兰医药杂志》
I accepted an invitation to give a talk in Michigan on a Tuesday in April, though the date rang some distant bell. A day or two later, I recognized the bell: that Tuesday was my son's ninth birthday. I called to reschedule the talk, citing the proverbial family complications — not specifying that the real complication was my own spaced-out incompetence. The incident left me feeling like a crummy mother, a rotten visiting lecturer, and a bad person — an apologetic trifecta of self-criticism. I would not be confessing this incident now had a friend not mentioned recently that she had inadvertently agreed to do moonlighting hospital coverage the weekend of her child's birthday. "I guess I was using my work brain instead of my home brain," she sighed guiltily.
My oldest child is 21, which means that I have been an "expert" on family-and-career for more than two decades. I have spoken on the subject to various groups, pontificated on panels and radio shows. And I have no right to complain about this role, because I asked for it — I wrote about having my first baby while I was in medical school, making a fuss in print about the complications of my life.
Even so, I don't like the family-and-career podium. From the first time I found myself standing in front of a room full of women, clutching notes about my life, I have always felt some irritation and embarrassment about the subject. Consider, for example, the serious, note-taking undergraduates who ask earnestly whether the right time to have children is during medical school or residency. I suppress my maternal — and pediatric — inclination to tell them that, at their age, they should concentrate on avoiding unwanted pregnancies. Instead, I tell them, honestly but unhelpfully, that there is never a right time to have a baby. It will always be a lot of work, a tremendous expense, an enormous commitment stretching into the uncertain future — and a big distraction from a medical career. Having a baby isn't something you do for the sake of logic; it's something that happens when the forces of sentiment, emotion, biology, and who knows what else sweep you away. Witness my own decision process about having that first child: I'm in medical school, financially dependent on my parents. . . . You're in graduate school; heaven knows where you'll get a job. . . . We have no money, a tiny apartment, heavy workloads, an uncertain future. . . . Hey! Let's have a baby! Best decision I ever made.
Holding forth about family-and-career does give one a certain egocentric joy in one's own domestic and professional arrangements. Look at all those people listening and nodding and laughing; afterward they'll tell me how helpful it is to hear from women who've really done it. (Why, my life must really be of great interest to all and sundry! Perhaps I really knew what I was doing!) But in the end, other people's domestic and professional arrangements butter not a single parsnip in the complexities of your own busy life. I doubt anyone has ever come away from such a session with a single new or surprising idea. (Wow — that oncologist worked part-time while her kids were young, then went back to work full-time when they were out of the house! Hey — those surgeons put their children in something called a "day-care center"!)
For many years, I had a morning ritual on arriving at the health center. I would greet Eileen, another pediatrician and mother of three. We would stagger in, often a little late, our brains full of the not exactly harmonious noises of siblings in the car together or the sudden discovery that homemade costumes were due on Friday for the spring play. We would take deep breaths, exchange competitive stories to determine whose children had been more problematic, whose drive more encumbered. We would reflect on the logistic mountains already climbed that day, the dramas and tensions already vanquished — all before we even started work. And our shorthand for all this evolved into a ceremonial inquiry: "So where's my medal?"
Here is the thing about family-and-career: it is not a problem, or an issue especially for women, or a knotty dilemma amenable to clever tips. It's just what my life is: my family and my job and some little, harder-to-classify pieces of myself, floating around the edges. I won't come to any cosmic understanding of how to do it right. I'm simply going to live it day by day and year by year, with some good moments and some bad moments. The decisions, large and small, that I make along the way won't add up to a strategy; they'll add up to who I am. And even though women rarely ask men to expound on family-and-career — maybe because we understand that for a man, this is just another name for a full, busy, everyday life — it's as true for men as it is for women that these decisions will add up to who they are.
Surely we're all past the "either–or"; that approach has been dead and gone for decades. You make your own particular mixture. I could spend all my time and energy on my children, but then I wouldn't have my job, and my life would have less meaning. Or I could spend all my time and energy on my job, but then I wouldn't have my family, and my life would have less meaning. And that's about all there is to say and do about either–or — which leaves me with a lifetime of not-very-interesting logistics to tackle and some insights to glean along the way that I suspect are the kind you have to glean for yourself, the hard way.
For example, medicine attracts people who tend toward the obsessive, the driven, and the competitive. We might sublimate those qualities to altruism, but many physicians approach each new challenge with the secret desire to score well above the class median. And parenthood is yet another opportunity to perform — or an endless series of little opportunities, depending on how carefully you're keeping score. The sweaters and hats and mittens that I knitted for my children when they were young were both an expression of my affection and a hostile gesture toward those parents who might have more time than I to be involved in their children's schools and to go on class trips but who outfitted their children for the New England winter in soulless store-bought garments. Take that!
On the other hand, when you see someone going at the job of being a parent not just full-time but also full-tilt, with that same competitive energy, you have to tremble. I know parents who decided to make full-time vocations of their children, applying the same intensity that they might apply to making partner in a big law firm, going at every day as if to squeeze out as many billable hours as possible. I have inculcated in my children (in sheer self-defense) a wariness about too-attentive parents, a sense that those parents are just the kind who would show up in school to lead a special project or, god forbid, perform at an assembly.
My daughter Josephine, now a high-school student, recently spoke disapprovingly about a dear friend of mine. The friend runs the kind of organized home that I will never even aspire to, cares for her children with delightful spirit, and frequently pitches in to help me over bumps of my own making; she doesn't "work outside the home," as we say, but she clearly works very hard inside it. Josephine's father and I were surprised to hear her sound so disapproving; we had always assumed that she had measured our own household against my friend's and found ours wanting. "I thought you liked her," I said. "I do like her," said my daughter. "I just don't think much of her work ethic." There was a pause, as parental glances were exchanged, and then: "What do you think of our work ethics?" She surveyed us for a second, clearly writing off her father, the professor. "I think Mom has a pretty good work ethic," she said. "But I do think she should see more patients."
The further along I get with my family and my career, the less qualified I feel to talk about family-and-career. Yes, I can talk about all my work-related trips that were complicated by the minor illness of a child at home, of family vacations enlivened by my melting down about some patient and calling the health center from a pay phone in some foreign country to ask that a lab please be double-checked. Or about the predictable, long list of school performances I didn't attend because I had patients scheduled (and the shorter list of school performances I moved heaven and earth to attend, only to watch my son not bother to sing in the big second-grade number because he and another boy were too busy shoving each other and giggling).
And yes, I learned what I know of pediatrics as a mother of young children — and then as a mother of older children. I was the only resident in my clinic with a kid, and when a speaker about children and pets surveyed us residents about the right age for children to have a pet of their own, I was the only one who said 18. My family experiences inflect my speeches to my patients and my responses to their worries — and sometimes knowing that it's my day to pick up the children from their after-school activities adds an urgency to my last patient visit of the day. My children deal with me mostly as a mother, but they occasionally acknowledge my medical side. When my older son was in high school, I accompanied him to a checkup, and the doctor kicked me out of the room. On the way home, my son said that he was embarrassed to think that I probably knew exactly what his doctor had asked him in private. "Well," I said, "yes, I probably do know — but that doesn't mean I know your answers." "Even so," said my son, "it's kind of embarrassing." Those are the breaks: sometimes it's useful to have a mother who's a doctor, sometimes it's neutral, and sometimes it's a big pain in the neck.
Family-and-career. Every woman I know resents that it is still regarded as a women's issue. Every female doctor I know is aware that, however tricky her own balancing act may be, it can't compare with the difficulties and complexities endured by other women in our workplaces — the clerical staff, the medical assistants, the women juggling lower-paying jobs with much less power and authority but with the same family imperatives. And just as every reasonably wise physician comes eventually to the understanding that not all outcomes are optimal, so every marginally competent parent learns to accept the imperfections in our performance during this most important life assignment. You do your best, you count your blessings, and you try to clean up the spills.
I might have had a different career in medicine if I hadn't had children. I might have reared my children differently, or had children at different junctures, if I hadn't been training to be and then working as a doctor. But if I'd had my children at different moments, then they'd be different children — and I would have just x-ed out the people I love most in the dubious process of x-ing out myself.
In the end, the most difficult things about family life are also its greatest glories: the repetitive small-time daily drudgeries and the unexpected small-time daily joys, the accumulation of small-scale experiences and memories, the frustration of lessons that never get learned, and the occasional thrills of progress and inspiration. Come to think of it, raising a family is a lot like practicing primary care pediatrics, except that there are fewer forms to fill in and you don't have to pretend to be an expert.(Perri Klass, M.D.)
My oldest child is 21, which means that I have been an "expert" on family-and-career for more than two decades. I have spoken on the subject to various groups, pontificated on panels and radio shows. And I have no right to complain about this role, because I asked for it — I wrote about having my first baby while I was in medical school, making a fuss in print about the complications of my life.
Even so, I don't like the family-and-career podium. From the first time I found myself standing in front of a room full of women, clutching notes about my life, I have always felt some irritation and embarrassment about the subject. Consider, for example, the serious, note-taking undergraduates who ask earnestly whether the right time to have children is during medical school or residency. I suppress my maternal — and pediatric — inclination to tell them that, at their age, they should concentrate on avoiding unwanted pregnancies. Instead, I tell them, honestly but unhelpfully, that there is never a right time to have a baby. It will always be a lot of work, a tremendous expense, an enormous commitment stretching into the uncertain future — and a big distraction from a medical career. Having a baby isn't something you do for the sake of logic; it's something that happens when the forces of sentiment, emotion, biology, and who knows what else sweep you away. Witness my own decision process about having that first child: I'm in medical school, financially dependent on my parents. . . . You're in graduate school; heaven knows where you'll get a job. . . . We have no money, a tiny apartment, heavy workloads, an uncertain future. . . . Hey! Let's have a baby! Best decision I ever made.
Holding forth about family-and-career does give one a certain egocentric joy in one's own domestic and professional arrangements. Look at all those people listening and nodding and laughing; afterward they'll tell me how helpful it is to hear from women who've really done it. (Why, my life must really be of great interest to all and sundry! Perhaps I really knew what I was doing!) But in the end, other people's domestic and professional arrangements butter not a single parsnip in the complexities of your own busy life. I doubt anyone has ever come away from such a session with a single new or surprising idea. (Wow — that oncologist worked part-time while her kids were young, then went back to work full-time when they were out of the house! Hey — those surgeons put their children in something called a "day-care center"!)
For many years, I had a morning ritual on arriving at the health center. I would greet Eileen, another pediatrician and mother of three. We would stagger in, often a little late, our brains full of the not exactly harmonious noises of siblings in the car together or the sudden discovery that homemade costumes were due on Friday for the spring play. We would take deep breaths, exchange competitive stories to determine whose children had been more problematic, whose drive more encumbered. We would reflect on the logistic mountains already climbed that day, the dramas and tensions already vanquished — all before we even started work. And our shorthand for all this evolved into a ceremonial inquiry: "So where's my medal?"
Here is the thing about family-and-career: it is not a problem, or an issue especially for women, or a knotty dilemma amenable to clever tips. It's just what my life is: my family and my job and some little, harder-to-classify pieces of myself, floating around the edges. I won't come to any cosmic understanding of how to do it right. I'm simply going to live it day by day and year by year, with some good moments and some bad moments. The decisions, large and small, that I make along the way won't add up to a strategy; they'll add up to who I am. And even though women rarely ask men to expound on family-and-career — maybe because we understand that for a man, this is just another name for a full, busy, everyday life — it's as true for men as it is for women that these decisions will add up to who they are.
Surely we're all past the "either–or"; that approach has been dead and gone for decades. You make your own particular mixture. I could spend all my time and energy on my children, but then I wouldn't have my job, and my life would have less meaning. Or I could spend all my time and energy on my job, but then I wouldn't have my family, and my life would have less meaning. And that's about all there is to say and do about either–or — which leaves me with a lifetime of not-very-interesting logistics to tackle and some insights to glean along the way that I suspect are the kind you have to glean for yourself, the hard way.
For example, medicine attracts people who tend toward the obsessive, the driven, and the competitive. We might sublimate those qualities to altruism, but many physicians approach each new challenge with the secret desire to score well above the class median. And parenthood is yet another opportunity to perform — or an endless series of little opportunities, depending on how carefully you're keeping score. The sweaters and hats and mittens that I knitted for my children when they were young were both an expression of my affection and a hostile gesture toward those parents who might have more time than I to be involved in their children's schools and to go on class trips but who outfitted their children for the New England winter in soulless store-bought garments. Take that!
On the other hand, when you see someone going at the job of being a parent not just full-time but also full-tilt, with that same competitive energy, you have to tremble. I know parents who decided to make full-time vocations of their children, applying the same intensity that they might apply to making partner in a big law firm, going at every day as if to squeeze out as many billable hours as possible. I have inculcated in my children (in sheer self-defense) a wariness about too-attentive parents, a sense that those parents are just the kind who would show up in school to lead a special project or, god forbid, perform at an assembly.
My daughter Josephine, now a high-school student, recently spoke disapprovingly about a dear friend of mine. The friend runs the kind of organized home that I will never even aspire to, cares for her children with delightful spirit, and frequently pitches in to help me over bumps of my own making; she doesn't "work outside the home," as we say, but she clearly works very hard inside it. Josephine's father and I were surprised to hear her sound so disapproving; we had always assumed that she had measured our own household against my friend's and found ours wanting. "I thought you liked her," I said. "I do like her," said my daughter. "I just don't think much of her work ethic." There was a pause, as parental glances were exchanged, and then: "What do you think of our work ethics?" She surveyed us for a second, clearly writing off her father, the professor. "I think Mom has a pretty good work ethic," she said. "But I do think she should see more patients."
The further along I get with my family and my career, the less qualified I feel to talk about family-and-career. Yes, I can talk about all my work-related trips that were complicated by the minor illness of a child at home, of family vacations enlivened by my melting down about some patient and calling the health center from a pay phone in some foreign country to ask that a lab please be double-checked. Or about the predictable, long list of school performances I didn't attend because I had patients scheduled (and the shorter list of school performances I moved heaven and earth to attend, only to watch my son not bother to sing in the big second-grade number because he and another boy were too busy shoving each other and giggling).
And yes, I learned what I know of pediatrics as a mother of young children — and then as a mother of older children. I was the only resident in my clinic with a kid, and when a speaker about children and pets surveyed us residents about the right age for children to have a pet of their own, I was the only one who said 18. My family experiences inflect my speeches to my patients and my responses to their worries — and sometimes knowing that it's my day to pick up the children from their after-school activities adds an urgency to my last patient visit of the day. My children deal with me mostly as a mother, but they occasionally acknowledge my medical side. When my older son was in high school, I accompanied him to a checkup, and the doctor kicked me out of the room. On the way home, my son said that he was embarrassed to think that I probably knew exactly what his doctor had asked him in private. "Well," I said, "yes, I probably do know — but that doesn't mean I know your answers." "Even so," said my son, "it's kind of embarrassing." Those are the breaks: sometimes it's useful to have a mother who's a doctor, sometimes it's neutral, and sometimes it's a big pain in the neck.
Family-and-career. Every woman I know resents that it is still regarded as a women's issue. Every female doctor I know is aware that, however tricky her own balancing act may be, it can't compare with the difficulties and complexities endured by other women in our workplaces — the clerical staff, the medical assistants, the women juggling lower-paying jobs with much less power and authority but with the same family imperatives. And just as every reasonably wise physician comes eventually to the understanding that not all outcomes are optimal, so every marginally competent parent learns to accept the imperfections in our performance during this most important life assignment. You do your best, you count your blessings, and you try to clean up the spills.
I might have had a different career in medicine if I hadn't had children. I might have reared my children differently, or had children at different junctures, if I hadn't been training to be and then working as a doctor. But if I'd had my children at different moments, then they'd be different children — and I would have just x-ed out the people I love most in the dubious process of x-ing out myself.
In the end, the most difficult things about family life are also its greatest glories: the repetitive small-time daily drudgeries and the unexpected small-time daily joys, the accumulation of small-scale experiences and memories, the frustration of lessons that never get learned, and the occasional thrills of progress and inspiration. Come to think of it, raising a family is a lot like practicing primary care pediatrics, except that there are fewer forms to fill in and you don't have to pretend to be an expert.(Perri Klass, M.D.)