“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!

In return for dedication during the tough months, the agreement that has worked for us is to pay the nanny a generous set weekly fee regardless of her work hours. My husband and I even took separate vacation time so that the nanny could have more, and well deserved, paid time off.

Make time for your spouse. Lack of couple time is an issue whether there are two residents or one. The benefit to having one nonresident spouse is that one person keeps the family running and allows the resident to focus on doing the job well. But it is easy for spouses with different careers to wind up resenting each other if they lack understanding of the other spouse’s challenges. The non-resident spouse generally winds up carrying the largest load of family responsibilities and may feel abandoned by the resident spouse. The overworked resident who complains about work challenges often feels underappreciated, and both spouses can feel misunderstood. With little energy left for family time, it is important for residents to schedule and prioritize couple time and to remember that both spouses are contributing to their future as a family.

When both spouses are residents, the children barely have parents for a time. To address this, we sat down with the calendar as soon as the rotation schedules were announced. The trick was remembering to schedule sleep time. Residents without kids have time to themselves, but parents must remember to schedule child care coverage for everything, including daytime sleeping. Scheduling for our family became even more complicated when my husband became chief resident. Communication became even more important when he had additional meetings that were not scheduled clinical shifts.

One of our real benefits as a two-resident family, especially in the same program and the same specialty, has been the tremendous understanding of each other’s challenges. At the end of a rough day, I am thankful to come home to a husband who absolutely understands what I go through. My husband walks in my shoes and really understands my venting. When something was painful at work, just a quick text message of encouragement from my husband was enough to help me finish my shift.

Celebrating birthdays and participating in school events are important. Because of work schedules, I have missed most actual birthdays and am unable to participate in most school activities. Instead, we eventually have small home celebrations, and ask the nanny to plan the “friends birthday party” on a rare day when Mom and Dad are both off work. We solved the challenge of parent/teacher conferences by writing emails and scheduling occasional phone calls.

Even minor household tasks take time. Paying bills, doing chores, and running errands become big challenges for two residents working many 12-hour nights in a row. I pay bills online or via my cell phone, with text reminders of due dates. Brief tasks like this can be done while I’m waiting at the kids’ ballet or gymnastics classes. Grocery delivery is an option when there is no time for shopping. Instead of remembering school lunch money each day, I can pay online – even at 3 a.m.

Set a schedule for study time. With an intense work schedule and no downtime at home, making a study schedule helped me to study in small bits. Just looking at Rosen’s or Tintinalli’s can be overwhelming. But a schedule makes it seem more do-able over time. It is also a constant reminder on my calendar to not let my guard down since I have “miles to go before I rest.” There is an endless supply of charts, logs and conference presentations to prepare. Scheduling time for everything helps me to stay organized.

Any time with the kids is real time. When I am home I am generally busy with presentations, patient logs, studying, or other residency related chores. But I still take breaks with the kids. We sit on the floor and I do whatever the kids want to do: braid hair, play a board game, put on fake tattoos, do ballet together, watch the Disney channel, or turn on music and “crazy dance.”

I will never forget my first Christmas as an intern. My husband’s mother supplied all the presents. The tree was tiny and put up at the last minute. Both my husband and I worked Christmas. When I left at 6 a.m., the kids were asleep. Santa’s presents were under the tree. I cried as I glanced back to the quiet living room, knowing that my children would run in to see what Santa brought … and I wouldn’t be there. A nurse caught me crying later during my shift. I still appreciate her hugs. Her kids were home celebrating without her, too. People still get sick on the holidays, and it is our job to be there for them.

The guilt of missing important events in my children’s lives is painful. I sometime wonder if it is all worth it. This self-doubt usually comes over me when I am sleep deprived and exhausted. I am reassured that I made the right choice when my kids call me “SuperMom” or when I get text messages from my sons saying, “so proud of you Mom, you can do it.”

Find what keeps you going and celebrate it. The excitement that I feel when I have a sick patient and I know what to do to help that person in the critical moments … getting a difficult airway…a bloody shot to the face…finding those beautiful vocal cords on the first try … makes it all worth the exhaustion and the sacrifices. I love the feeling of educating patients about their medical issues. When the occasional patient thanks me for helping, it makes up for all the agitated patients who spit on me.

Seek out other resident/parents and share your stories. If you are a new ED resident/parent, remember what worked for me. Find a good nanny and treat her well. Respect your spouse’s challenges and make couple time; text each other and chat when you can. Schedule your study time. Sit on the floor with your kids as often as possible. Pay your bills and shop online. Pray. Remember why you went into medicine and remember your values in the midst of the battle. And most of all, forgive yourself for not being perfect.

And remember, in the words of Mel Herbert: “What you do matters.”

If you would like to be included on our Facebook ED resident/parent group, send a friend request to K. Kay Moody, letting me know that you are an ED resident/parent. I will add you to the group and we can all share ideas on how to survive and balance being good parents while learning to be an emergemcy physician.

Dr. K. Kay Moody is a resident at Albert Einstein Medical Center, Philadelphia. She is the resident representative on the board of the ACEP Pennsylvania chapter.