Small Sacrifices

They are young and eager. A little anxious at being confronted with a real patient, performing their first real physical examination. Their white coats shine as they plumb the mysteries of stethoscopes, otoscopes, and sphygmomanometers.

One of the joys of being a doctor is teaching these students the art of medicine. My favorite assignment is helping the second-year medical students learn to interview and examine patients. It is also one of the few chances I have to hear about medical education from the students' point of view.

My last two students seemed much like the others, two young women, bright, hard-working. A casual conversation established that, like myself, one of them had a young child.

“What do you do for child care?” I asked. A difficult problem, we agreed. So difficult, in fact, my young student confessed, that during her first year she had sent her 1-year-old child hundreds of miles away to live with her mother.

I was shocked.

“That must have been hard,” I said, hiding my feelings.

“Yes, ” she said. “He's back with me now, he calls me mommy—but he goes with anyone, as though I am nobody special”

I remembered how I had felt when my own daughter was 16 months old and I left her for the first time. I had been chosen to attend a national training session. It was important for my career. It seemed as if I were gone for an eternity; I missed Sarah desperately. When I returned, my husband was at the airport. He had dressed Sarah in a frilly pink sunsuit. I took her in my arms. She went limp. Her eyes, looking into mine, were vacant. She let me carry her for awhile, then reached out to go to her father. And for another eternity, it seemed, she would sit in anyone's lap but mine.

This was not the first time a female physician had told me she had sent her child away to a distant relative in order to complete some portion of training. The first time I had heard of this, I thought it was just an aberration. How could she do it, I wondered. She must not feel the way I do. Perhaps she lacks some maternal instinct. Maybe she just didn't bond. But confronted with this second instance, I raged inwardly against a system that pretends to teach humanism while destroying humanity.

“Can our medical schools make no concessions to the next generation?” I asked.

Then I remembered my own first year in medical school. The acceptance letter and the positive pregnancy test came one right after the other. There was never a doubt in my mind as to what I would do. And never a twinge of conscience. Until now.

Once again, I have the opportunity to attend a national meeting. It will be held on my daughter's fifth birthday.

• Copyright ©2004 by the American College of Physicians