“How do you do all that?!”

It’s a question I hear frequently when people discover that I am an EM resident who has five children and a husband who is a new attending. The truth is I always feel like I am running full speed just to keep up. The challenges of being a parent are intense. The challenges of being a resident are intense.

But I have found some solutions along the way to manage the demands. Hopefully, sharing my experiences will help other EM residents and parents, as well as medical students considering emrgency medicine as a career, to gain some tips for surviving the demands.

You need to carve out time for yourself, professionally and personally, as well as your children and your spouse. Making that happen means establishing a schedule for medical and dental appointments; children’s homework, activities, and school events; taking care of bills, chores, and errands; going to church, getting exercise, preparing presentations, attending conferences, studying, updating charts and logs … the list goes on and on.

Reliable child care is a must. No one can focus when they are worried about their kids. To juggle so many demands, parents working in emergency medicine need to have reliable child care, and a plan for caring for sick children. Ideally, this includes family members, but, in our case, the closest was more than 1,100 miles away.

Initially we tried a day-care arrangement, but within 1 month we realized that day care schedules are not designed for families with two resident parents who work nights, weekends, and holidays. We decided we needed a reliable, consistent caregiver and were fortunate to find a nanny through an online nanny agency, care.com. She has been wonderful, and continues to work with us.

I think our arrangement has worked so well because we were completely honest with her regarding our expectations. We explained from the start that our schedules would be “all over the place and ever changing.” We also set the rule that no one calls out sick: “If I’m sick, I work. If you’re sick, come anyway. If my kids are sick, everybody works. If your kids are sick, bring them with you.”

Our nanny worked with the understanding that we had to be a team and to do whatever it takes so that we never missed a shift. Sometimes that meant that the nanny stayed so that one of us could sleep after a night or on-call shift. Without establishing this understanding from the beginning, some nannies may run away after the first few ICU months. In busy months, this can mean that the nanny hardly ever leaves!