Mental health is difficult to define. According to Freud, mental health implies success in both love and work. Finding the right balance between love and work (and we would like to add play) in today’s world of two-career families is the most challenging of tasks. When there is imbalance between the two, there is risk to mental health, since the inability to solve the multiple dilemmas of career and family leads to demoralization, career angst, and divorce.
This essay is written from a perspective of nearly 41 years in our two-career family in medicine and our mostly successful effort to balance work and love. We will describe our story, commenting editorially on various critical choices and junctures in our ongoing effort to maintain homeostasis in the face of pressures deriving from our medical careers and our growing family. We are not saying that our solutions are the best or ideal ones, and we only hint at the emotional consequences of different tradeoffs that we have encountered. We believe, however, that the explicit nature of our choices has worked. We have worked at it over the years, and we believe the process is key. There is no substitute for this “work”—communicating, sharing, disagreeing, making midcourse modifications in planning, and reevaluating where we are as a family and in our careers. We try to pay close attention to each other—our needs and aspirations—and we pay closest attention to time management, as that is the most difficult “budget” to deal with. When we fail at this task, which we do regularly, we work at establishing a new balance to manage the tasks of work and love.
We met in medical school in the mid-1960s. At that time, few women were in medical school. In fact, in our class at Albert Einstein in New York, there were only five women in a class of 105. As luck would have it, we met the first day in anatomy lab; being in alphabetical order, we were assigned as cadaver partners. Our collaboration over the body was an intense experience (as it is for most medical students) and, in our case, led to a special closeness in work that matured into romance (with many envious and some ribald jokes from classmates) and then marriage at the end of the first year of medical school. We continued to work together on all rotations throughout the second and third years of medical school, right up until our surgical rotation.
The experience of operating on a live animal (in our case, a dog) led to interpersonal stress as we tried to be a team operating on this dog. One of us (Margaret) was quite skilled at sewing, and the other (Steven) was quite a klutz. After one particularly brutal experience in which a finger was clamped in the process (we will not say whose or by whom), we decided over dinner and drinks that night that we would begin to go on separate rotations for the rest of medical school and, indeed, pursue separate specialties, with Margaret going into pediatrics and Steven, psychiatry.
A key choice was the timing of our first child. During our internship and despite being on call every other night and every other weekend and sometimes being out of sync with each other, “we” managed to get pregnant. In the middle of this pregnancy, we moved to Boston for our respective residencies. Pregnancy itself turned out to be a stressful event, as again, in the era in which we trained, it was uncommon and considered to be very poor form for a female physician to become pregnant, and particularly to be a pregnant house officer. Despite the fact that Margaret had notified her program in Boston in advance, the program, and especially those women who were in it, took a very dim view of Margaret having a baby as a resident. After delivery, as psychiatry had a much better on-call arrangement than pediatrics, it became important for Steven to bring our son down every other weekend and every third night so that Margaret could see, feed, and play with this wonderful new arrival.
As much as Steven enjoyed being the primary caregiver for our son, it became clear that Margaret wanted and needed more time with him. In the context of the stressor of being in a residency program that did not appreciate the particular set of choices we were making, Margaret transferred to a different program, where a half-time opportunity presented itself. After an explicit discussion, we changed roles, with Margaret becoming the primary caregiver and Steven becoming much more focused on career development. Our parents were important in this decision, and it is significant to note that our parents had lots of questions about Margaret continuing to work at all. We had to set firm limits with them that this indeed would happen and that we were working on a part-time solution for Margaret. There were many phone calls, some angry conversations, and a few shed tears.
After our training years in Boston, we moved to the Washington, D.C., area so that Steven could pursue his public health service obligation and Margaret could continue in a half-time position at a local health center. Despite Steven’s career ambitions, we made a rule that he would be home every night for dinner and to help put the now two (soon to be three) children to sleep. In addition, Steven developed a home-based independent practice, which was part-time, given that his full-time work was in the government at NIMH. The balance of being home during critical awake hours, seeing patients in a home office, and working in government was maintained for the next several decades.
This was a typical day during our child-rearing days: We would both participate in getting breakfast and the kids ready for school. Margaret would arrive at work at 9:00 and would be home by 2:00; Steven would arrive at work at 9:00 and would be home by 6:00. Margaret would prepare dinner; we would eat together. Steven would clear and do the dishes and then go to the home office in our basement by 7:30 to see his first patient. Margaret would put the children to sleep. Steven would emerge at 9:30 for some individual time with Margaret.
A comment about child care: We decided that we would not economize on child care, and we only hired the best full-time day workers who would come into our house for our small children. This was costly, and indeed most, if not all, of Margaret’s salary went to this child care priority. In addition, our children’s needs always had first priority, and we were both there for all special events and important milestones during their growing years. However, in order to accomplish this, it took the efforts of many people, not only our devoted child care help, but also help from our parents, who were available for babysitting, for vacations, for whatever, in order to allow us to continue to find the balance between work and family and personal life.
We always took long vacations together, and as our family grew to three children, we continued an explicit conversation on the division of work and love, constantly making adjustments in terms of time and place. After 25 years, we became empty nesters and entered into the next phase of balance between aging parents and our children, who became adults, married, and had our first grandchildren. Indeed, Margaret has said a number of times that occasionally she feels like “grilled cheese,” as we are the sandwich generation between increasingly frail parents and children who are very career-oriented and wanting help similar to the help that we received from our parents when our children were small. So, flexibility throughout the family life cycle is critical (1, 2).
There is no right or wrong way to achieve this balance. Indeed, every day is a balancing act. It is important to always know when a situation is out of balance. Other two-career families have worked out a different set of priorities with different choices for work and play and love (3), but one commonality for all is that “it takes a village,” and we all need help, both paid and unpaid, in being able to achieve these goals.
Now as we begin to think of our own aging, we travel together, and we make real efforts to continue to see our kids, who have lived in different cities, and to be very close to our grandchildren. It has been a very pleasurable ride, which we hope to continue through the next several decades.