continuity of care

Let's talk, for a moment, about childcare.

It's a topic that I've meant to discuss for a while, and certainly I addressed it a little bit in my book, but as a family with two parents who work long variable hours outside of the home full-time, our childcare issues fall into a specific subset.  That is to say, without putting too fine a point on it, that we are utterly, utterly dependent on full-time, reliable childcare in order to function day-to-day.  Neither Joe nor I work part-time or any kind of variable/abbreviated hours.  We both work in the OR, which means we invariably leave home before sunrise, before the kids wake up.  We both take overnight call on a rotating basis.  This is not to be self-congratulatory or masochistic, and does not make us better or worse parents (though I'm sure there are those that would argue each side), it's just the life we lead and we've found a solution that works best for us.

However, before I get into the specifics of childcare, let me say first that none of this could work without an equal, fully-invested partner in parenting.  Joe and I had Cal early on in our medical residencies.  We were both at a critical point in our training, and both of us had responsibilities to our jobs and our patients that were equivalent and inarguably important.  So we've always, always, always viewed the division on parenting responsibility 50-50.  There were some minor variances here and there (for example: more difficult rotations month-to-month, the fact that Joe never got post-call days off but occasionally would get to leave for work later than I did, etc.) but on the whole, from the moment we first became parents, it's been right down the line.  We make sure one of us is always home every single night--if we need to, we'll trade call or make pre-emptive schedule requests to ensure that this is the case.  If I'm going to be home late, Joe tries to get out earlier.  If Joe has a journal article that he's getting ready to submit, I watch the kids.  We both have demanding jobs but this obviously doesn't make parenthood itself any less so, therefore when it comes to childcare, we've always been of the philosophy that "if you can't do it, I'll try to do it" and vice versa.

However, the fact is that both of us work all day on most days, and as such, we need to have a childcare solution to cover those working hours.  What we have, and what we have always had, is a full-time nanny.  I know this is a bad word for some people, and I can almost hear the squelching sound from the pile of shit that I am stepping in by telling you that I choose to practice medicine full-time and employ a nanny, but there it is.  We pay someone to watch our kids during the day so that we can go to work.

In residency, it was unavoidable.  We were in New York at the time, but having family members take care of the baby was not an option (both of my parents are also physicians that work full-time, and besides, they did not want nor should they have felt obligated to drop their practices in order to take care of their grandchild--they worked full time even while raising their own kids, after all; and Joe's parents, while both retired, live in Ohio).  We also had the kinds of jobs that were not amenable to a daycare-type solution.  I know that some dual-resident families make daycare work for them, but like I mentioned before, Joe and I both have OR-based specialties, and as such, we were both expected to be at work well before most daycare centers opened--and yes, this includes the hospital-based daycare at Columbia.  So we hired someone to come to our house, take care of the baby, and stay with him until one of us got home in the evenings.

As I've undoubtedly pointed out many times in the past for those in similar situations, finding a nanny, particularly as a medical trainee, is not simple.  First of all is the matter of the hours--it is difficult to say the least to find someone willing to show up at 5:45 every single morning, and for most nannies it's a dealbreaker.  The variability of the hours is also a problem--you have to understand that most nannies in New York (and certainly elsewhere) can find much more agreeable hours in basically in basically any other household.  A third issue is, obviously, the cost.  Childcare to this day is our number one largest household expense, but that's probably as it should be.  There was a period of time (before we finished residency) where our nanny was getting paid more than either Joe or I was for working at the hospital.  But this is the solution that has worked best for us--the only tenable solution really--and over the past six years, we've always had a full-time nanny.  Our current nanny has been with us for the past three and a half years, since we first moved to Atlanta.  She loves the kids, and they love her.  She's family.

Even now, that both of our kids are in school (Mack goes to preschool all day, three days a week), we still employ our nanny full-time, because Joe and I leave for work too early to drop off, and for the most part work too late to pick up from school.  And there are all the school holidays that are not hospital holidays.  Presidents Day and MLK Day and Teacher Planning Day (SO MANY DAYS FOR PLANNING) that we need someone to stay with the kids, to say nothing for the unexpected off days--snow days, ice days, sick days.  I know in the eyes of many Joe and I must be monsters for not taking off days from work when the kids are home sick from school, and who knows, maybe we are, especially since we are leaving our sick kids in order to go take care of sick strangers.  But the fact of it is that school aged kids get minor stay-home-from-school illnesses, like, all the time, and as long as I assess that they are OK--and by that I mean able to take and keep down fluids, making good urine, not stuporous--I make them chicken noodle soup the night before and stock up on juice and Motrin and keep in touch with our nanny throughout the day.  And then in the evenings, either Joe or I gets home--occasionally even both of us--and we'll take it from there.

In many ways, our childcare model is much like the practice of medicine.  It's about continuity of care.  The way our household works, no one can be with the kids all the time, around the clock every single day--but we have a team, and we have a system, and we make sure that handoffs are careful and that the time each of us does spend with the children is of the highest quality.  One could argue that abbreviating the work schedule of one or both parents might be better for our kids (oh, who am I kidding--no one ever thinks that of Joe, mostly people ask me, "So, do you think you'll eventually go part time?") and I think that, for each individual household, that can be difficult to say.  But I choose--choose--to work full-time.  I don't speak for anyone else, I'm certainly not telling anyone else what to do, but this is what works best for our family.

I'll tell you something that I've noticed in particular.  Whenever the discussion comes up about work-life balance and the choices that we (mostly women) make, the discussion essentially gets boiled down an issue of financial burden versus parental responsibility, and it invariably seems that the sentiment is that if parents (mothers) have the option to work part-time or opt out of working outside the home, they should, for the good of the children.  That choosing to work outside the home full-time is either born of financial necessity ("we can't afford to get by on less than two full incomes") or selfishness, abdicating the responsibility of caring for ones own children in favor of escaping the drudgery of the homestead and having more disposable income for your minks and Rolexes and Lego Star Wars sets or what have you.  To this, I would like to present a third viewpoint.  The fact of it is: I like working.  Not because I feel indebted to the medical machine, not because I have to, I just like what I do.  I like being a doctor, I like practicing anesthesia.  I trained for almost a decade to take care of patients, I want to do it more than part-time, and I want to do it well.  This does not mean that doctors who work part-time (men or women) don't like medicine, or are worse/lesser doctors, or cheating the system.  It also does not mean those who choose to spend the working day apart from their children care any less about the well-being or upbringing of those children.  I can only speak for myself, but I honestly enjoy my responsibilities outside the home too, and my choice is to work full-time.

Are there weeks that I spend a little too much time at work and miss my kids?  Certainly.  Are there weeks that I wish I had an extra day or two outside of the hospital to just catch up with them, with myself, with anything?  No doubt.  Are there things that I miss for work that I wish I didn't have to--performances, class parties, sports days?  Oh lord, almost every month.  But no one said adulthood was easy, and parenthood is almost certainly less so.  One thing it is about is adaptation and compromise, and finding your niche in balancing parenthood and career, perhaps in some cases deciding to choose one over the other entirely.  And I feel fortunate in many respects to be in a profession fulfilling enough that the decision of how I want to divide my time between work and home is, indeed, a difficult one.

Thanks to the commenter in the last entry for bringing up the topic, and reminding me that it's one I've long wanted to talk about.  There are lots of niches, lots of solutions, we found the one that, for now, works best for us.  What about you?  Other working parents, what's your niche, and what adaptations and compromises have you found that work best for you?  (Everyone be nice please.)

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Oh, and here's one for you, pregnancy enthusiasts/perverts.  Me and Thing 3 at 15 weeks.  Unlike with Cal, I didn't take many expanding midsection pictures the last time around (until it got, like, crazy), but this time I am acutely aware that this is almost certainly the last time I will go through this particular fascinating biological process so I'm trying to savor it in all its bloaty, body-snatcher-y glory.  I took this picture inside my closet but cropped out the edges because no one needs to see that many pairs of scrubs and long sleeved T-shirts, NO ONE.

(If you work with me, I apologize--please try to unsee these pictures by the time we run into each other in OR or in the doctor's lounge while pretend not to be fighting over who gets to the coffee machine first.)