Anonymous Doctor

How can anyone not want to have kids?

I ask this, seriously, because there's pretty much nothing sadder than when a patient dies and there's no one to call. No family. No one. No one to bury them, no one to give their personal belongings to, no one to contact. It's like they never existed. They come in, they die, they're gone, and the entire world moves on like nothing happened.

And, yeah, having someone to grieve for you is a terrible reason to have kids, sure. If I think about it, it's a terrible reason, absolutely. Except the alternative seems so damn lonely. Friends go away when you get sick. Parents die. One spouse is (usually) going to die first. Nieces and nephews don't always care about you. Kids may not care either, but they show up. They hold your hand. They ask questions. They act like you matter.

Of course every patient matters, and no one's intentionally treating the ones who are alone in their rooms any differently from the ones with a constant stream of visitors, or a family holding vigil-- but it's absolutely the case that having someone in the hospital with you is a tremendous benefit. People make mistakes, and attentive family members sometimes catch them. Nurses and doctors don't always know the patient well enough to be able to tell when something's changing, when something's starting to go wrong. And having someone there means there's someone who can follow up if something seems like it's been forgotten, or to get the doctor when something's wrong. We're naturally going to spend more time in someone's room when there's someone to talk to, as opposed to when it's just the patient, alone, and hardly alert.

And when things are reaching the end? It's not a conscious decision, but how much motivation is there to fight for someone to last two more days when he has no one, he's suffering, there's no reason for someone in that position to still be alive. And maybe that's a good thing. Maybe families often fight too long, keep people alive for no reason, prolong the pain and suffering.

But I just can't imagine wanting to die alone. I can't imagine actively choosing a life where you've set yourself up for dying alone to be the most likely outcome. Obviously terrible things happen-- children predecease their parents, people become estranged, accidents happen without warning. But to intentionally set yourself up to be lonely in old age, to have no one-- it seems like such a tragedy.

It would be a shockingly unromantic Match.com profile. "Looking for someone to grieve when I die." But "looking for someone to grow old with" isn't so far off the point, and that's totally reasonable, right?

And yet this whole place-- this whole profession-- is so unfriendly to doctors with families. Residents can't take maternity leave-- they can take their four weeks of vacation in one chunk and then not get another break for a year. They can take (unpaid) time off but then they're off schedule for a fellowship and slow down their whole career. Everyone ends up working nights at some point, or at least being on call. You're on call every x nights, every x weekends, even in private practice. The job is priority 1. And 2. And 3. And maybe kids and a family can have some time after that. I know it's not unique to medicine, but you'd think medicine would understand. Medicine would know better. It doesn't. It's terrible. Pregnant residents are the subject of so much negative gossip-- "I can't believe she's having a baby" / "I can't believe she's taking 3 weeks off!" And residents with kids get no sympathy. "Why does he always want to leave so early?" Because he has a life and doesn't want to miss it. It can't be done in residency, it can't be done in med school, a woman who wants kids has to wait until she's in her thirties if she wants any semblance of a home life.

But why am I talking about this, I haven't been on a date in months. Ha.