* * Anonymous Doc

Wednesday, July 21, 2010

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.


  1. Why do some people not have kids?

    Easy -- some of us don't WANT children, and are perfectly happy to spoil other people's children.

  2. Really, for the cost of a kid compounded over the 50 years until I die, I could probably afford to get hospice care at the Playboy mansion.

    About 95% of all decisions I make are done without thinking about my eventual death, anyway.

    It also sucks to have your parents get sick and die -- I am a little angry at my parents for deciding to impose their end-of-life burden on me. Part of my decision not to have kids is to spare them that time in the hospital.

    And, once you're dead, you will not be remembering the pain or feeling unmourned-for anyway. You'll be dead. So it's a transitory sadness which I hope to shorten as much as possible once I see it coming (assuming right-to-die becomes legal).

  3. Work life in general, I feel, is very unfriendly to families. But the amount of hours you guys work is beyond anything that could resemble family friendly or even healthy.

    That said, go ahead and give some girl some hand picked flowers today. Giving away smiles freely is a sure way of getting threefold in return.

  4. It has taken me about thirty years to really understand the mysteries of some of the points you have touched on. The most important one, how you make time for your own life and the life of your family, takes some thoughtful planning. My advice to you at this point? Do exactly what you must do to get excellent training at this phase of your life. It will be the real foundation you work off of for the rest of your life. Develop excellent habits (work, self care, reading, studying) and continue them always. Finally, when you have finished training, figure out what you want your life in medicine to look like and MAKE that happen any way you can. You will be much happier, your patients will be better served, and you will enjoy going to work every day. I am living that now, but I wish I'd known to do it twenty five years ago.

  5. I know this wasn't exactly the point of your post, but keep in mind that some people CAN'T have kids. It's not always an active choice.

    It actually seems like your post has hit on 2 different subjects... one being people having children, the other being people having relationships. The truth is, you probably don't really know much about this person's past... there are all sorts of reasons that could account for this person being alone at the end.

  6. do you listen to death cab for cutie?

    there's a song that hits close to this blog entry and the one about the homeless.

    "What Sarah Said"

    And it came to me then that every plan is a tiny prayer to father time
    As I stared at my shoes in the ICU that reeked of piss and 409
    And I rationed my breaths as I said to myself that I'd already taken too much today
    As each descending peak on the LCD took you a little farther away from me
    Away from me

    Amongst the vending machines and year-old magazines in a place where we only say goodbye
    It stung like a violent wind that our memories depend on a faulty camera in our minds
    But I knew that you were a truth I would rather lose than to have never lain beside at all
    And I looked around at all the eyes on the ground as the TV entertained itself

    'Cause there's no comfort in the waiting room
    Just nervous pacers bracing for bad news
    And then the nurse comes round and everyone will lift their heads
    But I'm thinking of what Sarah said that "Love is watching someone die"

    So who's going to watch you die?..

  7. I realize this is an old post, but you kind of answered your own question. How many people actually die, surrounded by and conscious of their loved ones? I see so many apathetic children who never see their eldery parents and surviving family members fighting over mom & dad's old stuff. I'm sure some peole do have that comforting farewell, but for many others they are going to face death alone no matter what. Once you're gone there is nothing left to regret; you don't exist.

    My reason for not having children is due to mental illnesses and other health issues. It's just not something I wish to inflict on a child.

  8. I would rather die alone. When I'm sick, I just want to be left alone. I don't want anyone fighting for one more day of life for me. I don't want anyone grieving, or sitting around waiting for me to just die.
    I'll push the call button if I need a bed pan or some water, or please, if you're willing, put a shot of something terminal in my IV. But otherwise, just close the door and let me go. Can I just turn this machine off, so it doesn't disturb you when I leave?

  9. I know a lot of of female OB/GYNS who are umarried and don't have children. Sad!