Dr. Mom’s Balancing Act

A pediatric specialist reflects on life as a mother and ER physician
illustration of female doctor with basket of apples
When my husband finished his fellowship, we both looked for jobs in the Northeast. We had a 2-year-old daughter and another baby on the way. How should we best balance our lives? Illustration: Hadley Hooper
December 4, 2012

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It was my turn to bring the apples. I was at toddler music class with eight other mommy-baby duos on a Tuesday morning. I am free Tuesday mornings because I am a pediatric ER doctor, and I work part time. This particular morning I was nervous, because the apples were at least a week old.

To be honest, I wasn’t sure how old—that week I had worked an overnight, which is always hard to recover from with two small kids at home, and I had spent extra time in meetings about a clinical pathway for managing abdominal pain in the emergency department. Plus, there had been the usual flurry of child-related activity: playgroups, fireworks, a Fourth of July pool party. But the apples looked OK. They were red and firm on the outside.

The first apple was fine. The teacher used a hand-held apple slicer, cutting the fruit open in front of the children to show them how it looked inside. She sang in rhyme as she worked: “Here is an apple chew for you!” But then she sliced the second apple. Her face fell. The inside was a rotten mess—brown and slimy, the seeds barely discernible from the surrounding flesh. “Oh my goodness,” she sang, holding out the apple to her wide-eyed students. “This one is brown; we can’t eat it!” My face burned red. I couldn’t meet the eyes of the other mommies in the room.

How had this happened? It was an equation malfunction—the term I now use when a piece of my delicately balanced life goes awry.

I am lucky in many ways. Growing up in the United States at the end of the 20th century, it was a given that I would go to college, and then become whatever I wanted. Married to a fellow physician, I can work full-time, part-time or not at all. It would seem, from the outside, that I can do anything I want.

Well, almost anything. When my husband finished his fellowship, we both looked for jobs in the Northeast. We had a 2-year-old daughter and another baby on the way. How should we best balance our lives?

We were finishing a grueling year in the Midwest, with my husband working as a fellow and me working full time in a busy emergency department. There was an avalanche of housework that was never completed, the cupboards were bare and laundry was outsourced to an incredibly energetic woman who picked up and dropped off on Fridays at 5 a.m., the only time that one of us was reliably home.

More importantly, holidays went unplanned and barely celebrated, birthdays were an afterthought, and my daughter spent 10 hours a day in day care. If she was sick, a babysitter from an agency picked her up and cared for her until one of us was home. This didn’t feel right.

Part-time academic. It came to me at a division meeting one day, scanning the room and considering the life of each woman in my group. Two of them worked part-time. They each had two children, an academic title and a significant list of publications. As part-time faculty, they were eligible for benefits, but not for tenure. I considered this tradeoff: family life versus the possibility of tenure. Family won.

The next day I got in touch with an old mentor at an academic medical center in New York City, and we set up a phone interview. “What sort of job are you looking for?” he asked.

“Part-time academic,” I said, relishing this new term and fully expecting a warm “welcome aboard.” Instead, I was met with silence. It was a lengthy silence, in which I slowly came to realize that my vision of a perfectly balanced life was not a shared vision.

Finally, he said, “I’m not really sure what you mean by that.”

And there I was, in unexpected territory. “Well,” I said, “I would work half the clinical hours of a full-time attending, and I would be involved in teaching and research.”

“That can be hard to do,” he said. He wasn’t unkind, but he also didn’t offer me a job.

A New Approach

Part-time academic jobs are a relatively new phenomenon. Young fellowship graduates are expected to hit the ground running, carve out a research niche and get an NIH grant in their first few years as an attending. And my old mentor was right—this can be very hard to do if you are the mother of small children. Or, put another way, if you are the author of your own equation—picking the variables, freely assigning their importance and weight—you can do anything you want, but it will be at the expense of something else.

Would that “something else” be my academic career? It seemed unfair. I’d spent four years completing my M.D. and M.P.H., then six years training to work in children’s emergency medicine. During my first year as an attending, I’d had the opportunity to teach at a continuing medical education course, and I was inspired by the experience. The conference hall was filled with people who cared for ill and injured children: physicians and surgeons, nurses and EMTs. When it was my turn to speak at the podium, I felt exhilarated. I was part of a community that could actually make the world a better place for children. Would I have to give this up to work part time?

Luckily not. New York City has five academic medical centers with children’s emergency rooms that I can reasonably commute to, and I had two offers for part-time work. I joined a 12-person group, five of whom are moms who work part-time. When I told my then-future division chief that my son was due two months after my start date, she wrote back, “Mazel tov! This will be fun.”

I’ve had my part-time academic job for two years. Every day is a carefully orchestrated production in which five people (parents, kids, babysitter) and two cars go in different directions. The rapid turnaround time and last-minute meetings of academic medicine require an enormous amount of creativity, flexibility and baby-sitting dollars. Institutional review board applications and clinical guidelines have been written at the Toyota dealer, the Starbucks down the road from my daughter’s nursery school, Grand Central Station and the parking lot of the public library (they closed early that day). Sometimes I miss out on a nursery school event. Sometimes I miss a meeting and fall out of the loop. And sometimes I bring rotten apples to music class.

But here’s what I get in return: my part-time job allows me to spend fewer nights in the ER and more at home. And on nights that I don’t work, I can put my kids to bed. My son is the youngest, so he goes first. He always smells sweet from the bath. I comb his mop of hair just so. Then he runs back and forth picking out his favorite books and nestles in my lap, little hands and feet adjusting themselves until he is quiet and comfortable. I rock him to sleep. If you told me, in those moments, that I was being promoted to surgeon general, I might not hear you. Or if I did, I might say, Call me back when he’s grown.

It is amazing how far women have come and how much we are able to do. While some external barriers remain, most of my challenges have to do with the equation that I built myself: the struggle among variables, the struggle to find the perfect balance between my family and my career.

About the bad apple—we didn’t eat it, of course. And the kids were fine, having survived their first lesson in decomposition. I wasn’t shunned by the group. In fact, I think the whole episode made me a sympathetic character. One mom asked for a playdate, another for medical advice.

This article first appeared in the Fall 2012 Tufts Medicine magazine.

Rachel Kowalsky is an assistant professor of pediatric emergency medicine at Weill Cornell Medical Center in New York City and the mother of two children.